Healthcare Provider Details

I. General information

NPI: 1861448839
Provider Name (Legal Business Name): MYRON C GARGIS L.C.S.W.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2409 HOMER CLAYTON DR
GUNTERSVILLE AL
35976-2207
US

IV. Provider business mailing address

119 COOPER DR
HUNTSVILLE AL
35811-9527
US

V. Phone/Fax

Practice location:
  • Phone: 256-582-3203
  • Fax: 256-582-3216
Mailing address:
  • Phone: 256-776-5603
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1442C
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: