Provider Demographics
NPI:1366485336
Name:PORTZER, JAMES L (DO)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:L
Last Name:PORTZER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 EXECUTIVE CIR
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-3345
Mailing Address - Country:US
Mailing Address - Phone:912-355-2400
Mailing Address - Fax:912-355-5324
Practice Address - Street 1:5 EXECUTIVE CIR
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-3345
Practice Address - Country:US
Practice Address - Phone:912-355-2400
Practice Address - Fax:912-355-5324
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC881207P00000X
GA058095208D00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000967018CMedicaid
GA000967018DMedicaid
SC000967018FMedicaid
GA000967018BMedicaid
GA000967018HMedicaid
GA10058867OtherAMERIGROUP
SCG58095Medicaid
GA000967018FMedicaid
GA000967018GMedicaid
GA000967018AMedicaid
SCG198798055Medicare PIN
GA000967018FMedicaid
G19879Medicare UPIN
SCG58095Medicaid
GA000967018BMedicaid