H Clark Deriso M.D.P.C.

Primary specialty

SpecialistTaxonomy code 174400000X

License

013026 Issued in GA

Legal business name

H CLARK DERISO M.D.P.C.

Practice address

38 Medical Arts Center
Savannah, GA 31405-4155

Phone

(912) 692-0755

Fax

(912) 692-0754

NPI assigned

Nov 30, 2007

Organization subpart

Yes

Parent organization

H. CLARK DERISO M.D.P.C.As reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Henry Clark Deriso, M.D.

Title

MD

Phone

(972) 692-0755

Specialties & licenses 1

Addresses

Other names 1

• H. Clark Deriso M.D.P.C. Doing business as

Part of

H C Deriso MD PC

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1196380800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1196899200000",
    "number": "1245412352",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "38 MEDICAL ARTS CTR",
            "city": "SAVANNAH",
            "state": "GA",
            "postal_code": "314054415",
            "telephone_number": "912-692-0755",
            "fax_number": "912-692-0754"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "38 MEDICAL ARTS CENTER",
            "city": "SAVANNAH",
            "state": "GA",
            "postal_code": "314054155",
            "telephone_number": "912-692-0755",
            "fax_number": "912-692-0754"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "H CLARK DERISO M.D.P.C.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "H. CLARK DERISO M.D.P.C.",
        "enumeration_date": "2007-11-30",
        "last_updated": "2007-12-06",
        "status": "A",
        "authorized_official_last_name": "DERISO",
        "authorized_official_first_name": "HENRY",
        "authorized_official_middle_name": "CLARK",
        "authorized_official_title_or_position": "MD",
        "authorized_official_telephone_number": "972-692-0755",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "GA",
            "license": "013026",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "H. Clark Deriso M.D.P.C.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Joseph R Gussler, MD
• Beth Ann Gust, LPN
• Zariah Guyton, RBT
• Olivia Barbara Gwynn, BA, RBT
• Shabryia Gwynn
• H&W Enterprises of NC LLC
• Zachary Haas, D.O.
• Quanzetta B Habbeb-Ullah, NP
• George Gilbert Haberman, M.D.
• Habersham Dental of Savannah LLC

• Specialist in Savannah, GA
• Providers in Savannah, GA by specialty
• Specialist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.