Basic Information
| Provider Information | |||||||||
| NPI: | 1962452250 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CARNEY | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | E | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4750 WATERS AVE STE 307 | ||||||||
| Address2: | |||||||||
| City: | SAVANNAH | ||||||||
| State: | GA | ||||||||
| PostalCode: | 314046268 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9123507914 | ||||||||
| FaxNumber: | 9123507973 | ||||||||
| Practice Location | |||||||||
| Address1: | 4750 WATERS AVE | ||||||||
| Address2: | SUITE 307 | ||||||||
| City: | SAVANNAH | ||||||||
| State: | GA | ||||||||
| PostalCode: | 314046200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9123507914 | ||||||||
| FaxNumber: | 9123507973 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/10/2006 | ||||||||
| LastUpdateDate: | 01/04/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086S0120X | 058399 | GA | Y | Allopathic & Osteopathic Physicians | Surgery | Pediatric Surgery |
ID Information
| ID | Type | State | Issuer | Description | GPA748 | 01 | SC | GROUP ID SC MEDICAID | OTHER | P00386142 | 01 | GA | RR MEDICARE | OTHER | 10067411 | 01 | GA | AMERIGROUP | OTHER | 52205984-001 | 01 | GA | BCBS | OTHER | CH5121 | 01 | GA | RR MEDICARE GROUP PIN | OTHER | 362713 | 01 | GA | WELLCARE | OTHER | 7703560 | 01 | GA | AETNA | OTHER | 944905479A | 05 | GA | MEDICAID | GRP3905 | 01 | GA | MEDICARE GROUP PIN | OTHER | 00002425248 07 | 01 | GA | UNITED HEALTHCARE | OTHER | 9342322 | 01 | GA | MULTIPLAN/PHCS | OTHER | G58399 | 05 | SC | MEDICAID |