Healthcare Provider Details

I. General information

NPI: 1447592712
Provider Name (Legal Business Name): GULF COAST CANCER CENTER AT BREWTON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2013
Last Update Date: 03/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1207 AZALEA PL
BREWTON AL
36426-1337
US

IV. Provider business mailing address

3330 PRESTON RIDGE RD 300
ALPHARETTA GA
30005-4508
US

V. Phone/Fax

Practice location:
  • Phone: 251-867-6544
  • Fax: 770-512-8937
Mailing address:
  • Phone: 770-350-0126
  • Fax: 770-350-6637

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: STEPHEN M. SAWRIE
Title or Position: CEO
Credential: MD
Phone: 251-948-7897