Provider Demographics
NPI:1689666075
Name:JOSEPH W DEHAVEN MD PC
Entity type:Organization
Organization Name:JOSEPH W DEHAVEN MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:W
Authorized Official - Last Name:DEHAVEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD PC
Authorized Official - Phone:912-355-1437
Mailing Address - Street 1:7001 HODGSON MEMORIAL DR
Mailing Address - Street 2:ST 2
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-2549
Mailing Address - Country:US
Mailing Address - Phone:912-355-1437
Mailing Address - Fax:912-353-8374
Practice Address - Street 1:7001 HODGSON MEMORIAL DR
Practice Address - Street 2:ST 2
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-2549
Practice Address - Country:US
Practice Address - Phone:912-355-1437
Practice Address - Fax:912-353-8374
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA20687207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00187195AMedicaid
20687Medicare ID - Type Unspecified
GA00187195AMedicaid
GRP3816Medicare ID - Type Unspecified