Healthcare Provider Details

I. General information

NPI: 1508433384
Provider Name (Legal Business Name): GREGORY SARGENT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2021
Last Update Date: 01/26/2023
Certification Date: 01/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6974 CHUNCHULA GEORGETOWN RD
CHUNCHULA AL
36521-3400
US

IV. Provider business mailing address

6974 CHUNCHULA GEORGETOWN RD
CHUNCHULA AL
36521-3400
US

V. Phone/Fax

Practice location:
  • Phone: 251-776-8697
  • Fax:
Mailing address:
  • Phone: 251-776-3946
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code342000000X
TaxonomyTransportation Network Company
License Number
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: