Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 79517 | GA |
Y | 111NI0900X | Internist | 79517 | GA |
N | 207RA0401X | Internist - Addiction Medicine | 79517 | GA |
NPI | 1790148260 |
---|---|
Provider Name | Spiro Mavromates |
First Address | Savannah, GA 31404-6220 |
Second Address | Savannah, GA 31404-6220 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/04/2016 |
Last Update Date | 17/12/2019 |