Healthcare Provider Details

I. General information

NPI: 1235136433
Provider Name (Legal Business Name): SARAH W GERMANSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2005
Last Update Date: 10/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

364 HONEYSUCKLE RD
DOTHAN AL
36305-1140
US

IV. Provider business mailing address

364 HONEYSUCKLE RD
DOTHAN AL
36305-1140
US

V. Phone/Fax

Practice location:
  • Phone: 334-794-8656
  • Fax: 877-389-4229
Mailing address:
  • Phone: 334-794-8656
  • Fax: 877-389-4229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number24270
License Number StateAL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier009917275
Identifier TypeMEDICAID
Identifier StateAL
Identifier Issuer
# 2
Identifier630738893
Identifier TypeOTHER
Identifier StateAL
Identifier IssuerTAX ID
# 3
Identifier392822822A
Identifier TypeMEDICAID
Identifier StateGA
Identifier Issuer
# 4
Identifier272657200
Identifier TypeMEDICAID
Identifier StateFL
Identifier IssuerFlorida Medicaid Provider ID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: