Provider Demographics
NPI:1871929653
Name:RENEWALMD HINESVILLE
Entity type:Organization
Organization Name:RENEWALMD HINESVILLE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PATIENT ACCOUNT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:KEEL
Authorized Official - Suffix:
Authorized Official - Credentials:CPC, CPB, CPRC
Authorized Official - Phone:912-920-5624
Mailing Address - Street 1:900 MOHAWK ST STE A
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31419-1772
Mailing Address - Country:US
Mailing Address - Phone:912-920-2090
Mailing Address - Fax:912-920-4114
Practice Address - Street 1:600 OGLETHORPE HWY
Practice Address - Street 2:SUITE B
Practice Address - City:HINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:31313
Practice Address - Country:US
Practice Address - Phone:912-920-2090
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RENEWALMD, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-09-24
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA45759208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty