PROVIDENT HEALTH SERVICES, INC. (NPI# 1679634612) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1679634612 |
| Entity Type | Organization |
| Organization Name | PROVIDENT HEALTH SERVICES, INC. |
| Other Organization Name | CLINICAL GENETICS ASSOCIATES |
| Practice Address |
4700 Waters Ave Savannah GA 31404-6220 |
| Mailing Address |
Po Box 933213 Atlanta GA 31193-3213 |
| Practice Telephone | 9123508490 |
| Practice Fax Number | 9123508199 |
| Mailing Telephone | 9123508490 |
| Mailing Fax Number | 9123508199 |
| Enumeration Date | 2006-12-13 |
| Last Update Date | 2007-11-12 |
| Authorized Official Name | ROBIN J. MADDOX (PROVIDER ENROLLMENT COORDINATOR) |
| Authorized Official Telephone | 9123509335 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207SG0203X |
Medical Genetics Specialization: Clinical Molecular Genetics |
Allopathic & Osteopathic Physicians | ||
| Y | 207SG0201X |
Medical Genetics Specialization: Clinical Genetics (M.D.) |
Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| SC | RR MEDICARE | DF7661 | 01 |
| Other Name | Type Code |
|---|---|
| Clinical Genetics Associates | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366519530 | Provident Health Services, Inc. | Surgery | 7 Mallet Way, Bluffton, SC 29910-6064 | 2006-11-30 |
| 1225199383 | Provident Health Services, Inc. | Surgery | 4700 Waters Ave, Savannah, GA 31404-6220 | 2006-12-13 |
| 1740341783 | Provident Health Services, Inc. | Family Medicine | 4700 Waters Ave, Memorial Health Hospitalists, Savannah, GA 31404-6220 | 2006-12-13 |
| 1700947900 | Provident Health Services, Inc. | Internal Medicine | 1101 Lexington Ave, Savannah, GA 31404-5502 | 2006-12-12 |
| 1346301546 | Provident Health Services, Inc. | Internal Medicine | 4700 Waters Ave, Heart and Vascular Building, Savannah, GA 31404-6220 | 2006-12-12 |
| 1093737041 | Provident Health Services, Inc. | Family Medicine | 4700 Waters Ave, Memorial Health Hospitalists, Savannah, GA 31404-6220 | 2006-07-25 |
| Street Address |
4700 WATERS AVE |
| City | SAVANNAH |
| State | GA |
| Zip Code | 31404-6220 |
| 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 |
| Find all providers in the same location | ||||
| 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 |
| Find all providers in zip 31404 | ||||
| Taxonomy Code | 207SG0201X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Medical Genetics |
| Specialization | Clinical Genetics (M.D.) |
| A clinical geneticist demonstrates competence in providing comprehensive diagnostic, management and counseling services for genetic disorders. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added] Additional Resources: American Board of Medical Genetics, 2007. http://www.abmg.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Medical Genetics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700410867 | Reem Hudaib | Medical Genetics | 1470 Bramlett Forest Trl, Lawrenceville, GA 30045-7281 | 2020-02-27 |
| 1902147093 | Stuart K. Shapira | Medical Genetics | 1600 Clifton Rd., Mailstop E-87, Atlanta, GA 30333 | 2013-03-14 |
| 1225229693 | Pediatrics & Genetics, LLC | Medical Genetics | 3586 Old Milton Pkwy, Alpharetta, GA 30005-4465 | 2007-08-09 |
| 1255345435 | Stephanie Burns Wechsler | Medical Genetics | 1365 Clifton Rd Ne Bldg B Ste B 2200, Atlanta, GA 30322-1013 | 2006-07-27 |
| 1497702872 | Vidya Krishnamurthy | Medical Genetics | 3510 Old Milton Pkwy, Alpharetta, GA 30005-4458 | 2006-05-30 |
| 1427513266 | Cynthia Ann Moore | Medical Genetics | 440 Prior St Se, Gainesville, GA 30501-3402 | 2019-02-06 |
| 1053730838 | Emily Black | Medical Genetics | 1365 Clifton Rd Ne Ste 2200, Atlanta, GA 30322 | 2014-04-09 |
| 1083030548 | Juanita Neira Fresneda | Medical Genetics | 1365 Clifton Rd Ne, Building B Suite 2200, Atlanta, GA 30322 | 2014-03-08 |
| 1093078305 | Rossana Lucia Sanchez Russo | Medical Genetics | 1365 Clifton Rd Ne Ste 2200, Atlanta, GA 30322-5307 | 2012-06-21 |
| 1811160609 | Hong Li | Medical Genetics | 2165 N Decatur Rd, Decatur, GA 30033-5307 | 2008-04-11 |
| Find all providers with the same taxonomy | ||||
Please comment or provide details below to improve the information on PROVIDENT HEALTH SERVICES, INC..
| 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.