GUY J. PETRUZZELLI (NPI# 1528045481) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1528045481 |
| Entity Type | Individual |
| Full Name | GUY J. PETRUZZELLI |
| Credential | MD, PHD |
| Practice Address |
4700 Waters Ave Savannah GA 31404 |
| Mailing Address |
4700 Waters Ave Savannah GA 31404-6220 |
| Practice Telephone | 9123502299 |
| Practice Fax Number | 9123502298 |
| Mailing Telephone | 9123502299 |
| Mailing Fax Number | 9123502298 |
| Enumeration Date | 2005-12-30 |
| Last Update Date | 2018-08-07 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Y00000X | Otolaryngology | 067957 | GA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| GA | RAILROAD MEDICARE | P01109154 | 01 |
| GA | 003124903A | 05 | |
| SC | GA1328 | 05 | |
| GA | RAILROAD MEDICARE | P01069298 | 01 |
| GA | 003124903B | 05 | |
| GA | WELLCARE | 691344 | 01 |
| Street Address |
4700 WATERS AVE |
| City | SAVANNAH |
| State | GA |
| Zip Code | 31404 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023012010 | Peter M Britt | Radiology | 4700 Waters Ave, Savannah, GA 31404-6220 | 2005-06-08 |
| 1255938288 | Mckenna Maria Valencia | Anesthesiologist Assistant | 4700 Waters Ave, Savannah, GA 31404-6220 | 2020-10-02 |
| 1184239451 | Avery Thomas Helms | Anesthesiologist Assistant | 4700 Waters Ave, Savannah, GA 31404-6220 | 2020-09-13 |
| 1619580800 | Matthew Shannon | Anesthesiologist Assistant | 4700 Waters Ave, Savannah, GA 31404-6220 | 2020-08-26 |
| 1679184840 | Anna Tincher | Anesthesiologist Assistant | 4700 Waters Ave, Savannah, GA 31404-6220 | 2020-08-12 |
| 1669083168 | Christie Vernon Klinginsmith | Anesthesiologist Assistant | 4700 Waters Ave, Savannah, GA 31404-6220 | 2020-08-10 |
| 1396355004 | Noah Radjenovic | Anesthesiologist Assistant | 4700 Waters Ave, Savannah, GA 31404-6220 | 2020-08-06 |
| 1558987115 | Alyssa Nadji | Registered Nurse | 4700 Waters Ave, Savannah, GA 31404-6220 | 2020-06-19 |
| 1952926065 | Mary Helen Ondriezek | Registered Nurse | 4700 Waters Ave, Savannah, GA 31404-6220 | 2020-06-15 |
| 1326661463 | Danielle Marie Carroll | Pharmacist | 4700 Waters Ave, Savannah, GA 31404-6220 | 2020-05-23 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043864580 | Carli A Boatright | Registered Nurse | 4750 Waters Ave Suite 206, Savannah, GA 31404 | 2019-08-01 |
| 1619530573 | Morgan Johnson | Student in an Organized Health Care Education/Training Program | Memorial Health University Medical Center, 4700 Waters Ave, Savannah, GA 31404 | 2019-04-17 |
| 1477050243 | Kevin Timperman | Student in an Organized Health Care Education/Training Program | 4700 Waters Avenus, Surgery Residency Program, Mhumc, Savannah, GA 31404 | 2018-04-09 |
| 1376048959 | Nina Jo Paletta | Student in an Organized Health Care Education/Training Program | Memorial University Medical Center, 4700 Waters Ave., Savannah, GA 31404 | 2018-03-27 |
| 1972036200 | Jose Adrian Lara Gonzalez | Student in an Organized Health Care Education/Training Program | 4700 Waters Ave, Memorial University Medical Center, Internal Medicine Residency Program, Savannah, GA 31404 | 2017-04-04 |
| 1407210396 | Lexie Hester Vaughn | Student in an Organized Health Care Education/Training Program | 1250 East 66th St, Savannah, GA 31404 | 2016-04-07 |
| 1336503291 | Miles Love | Student in an Organized Health Care Education/Training Program | 1250 East 66th Street, Savannah, GA 31404 | 2016-04-07 |
| 1134536881 | David Patch | Specialist/Technologist | Pediatric Residency Program, Memorial University, Medical Center 4700 Waters Avenue, Savannah, GA 31404 | 2014-07-15 |
| 1962846683 | Alan Danilo Zevallos | Internal Medicine | 4700 Waters Avenue, University Medical Center, Internal Medicine Residency Program, Memorial Health, Savannah, GA 31404 | 2013-04-24 |
| 1730446394 | Joshua Ryan Fann | Prosthetist | 3840 Waters Ave, Savannah, GA 31404 | 2012-04-19 |
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| Taxonomy Code | 207Y00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Otolaryngology |
| An otolaryngologist-head and neck surgeon provides comprehensive medical and surgical care for patients with diseases and disorders that affect the ears, nose, throat, the respiratory and upper alimentary systems and related structures of the head and neck. An otolaryngologist diagnoses and provides medical and/or surgical therapy or prevention of diseases, allergies, neoplasms, deformities, disorders and/or injuries of the ears, nose, sinuses, throat, respiratory and upper alimentary systems, face, jaws and the other head and neck systems. Head and neck oncology, facial plastic and reconstructive surgery and the treatment of disorders of hearing and voice are fundamental areas of expertise. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Otolaryngology, 2007. http://www.aboto.org/. American Osteopathic Board of Ophthalmology and Otolaryngology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Otolaryngology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Ophthalmology and Otolaryngology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295154748 | Tyler Keith Deblieux | Otolaryngology | 5356 Reynolds St Ste 505, Savannah, GA 31405-6017 | 2014-04-14 |
| 1245523554 | Adam Price Campbell | Otolaryngology | 4750 Waters Ave Ste 112, Savannah, GA 31404-6267 | 2011-05-19 |
| 1124252226 | Frank Hoffman | Otolaryngology | 6 Boar's Nest Lane, Savannah, GA 31411 | 2009-05-05 |
| 1285706309 | Diane Watkins Davis | Otolaryngology | 5201 Frederick St, Savannah, GA 31405-4501 | 2006-11-14 |
| 1841518917 | Jagadish D Navare | Otolaryngology | 322 Commercial Dr, Savannah, GA 31406-3625 | 2010-05-13 |
| 1558517466 | Ear, Nose & Throat Associates of Savannah, P.C. | Otolaryngology | 13040 Abercorn St, Suite 1, Savannah, GA 31419-1955 | 2008-08-12 |
| 1497917975 | Brad A Rawlings | Otolaryngology | 5201 Frederick St, Savannah, GA 31405-4501 | 2008-06-26 |
| 1134322142 | Ear, Nose & Throat Associates of Savannah, PC | Otolaryngology | 5201 Frederick Street, Savannah, GA 31405-4501 | 2007-06-07 |
| 1871614297 | William H Moretz IIi | Otolaryngology | 5201 Frederick Street, Savannah, GA 31405-4501 | 2007-04-03 |
| 1790829950 | Georgia Nasal & Sinus Institute, PC | Otolaryngology | 4750 Waters Ave, Suite 112, Savannah, GA 31404-6200 | 2007-02-19 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.