Provider Demographics
NPI:1629018403
Name:SAAVEDRA, GEORGE GAVIOLA (MD)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:GAVIOLA
Last Name:SAAVEDRA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:GEORGE
Other - Middle Name:GAVIOLA
Other - Last Name:SAAVEDRA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:211 BURNHAM CT
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29414-6870
Mailing Address - Country:US
Mailing Address - Phone:843-556-2319
Mailing Address - Fax:843-556-2319
Practice Address - Street 1:9181 MEDCOM ST
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-9168
Practice Address - Country:US
Practice Address - Phone:843-820-7767
Practice Address - Fax:843-820-7798
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC19285208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC19285-6Medicaid
SCP00105968OtherPHYSICIAN
SCP00105968OtherPHYSICIAN