Healthcare Provider Details

I. General information

NPI: 1992923973
Provider Name (Legal Business Name): DR J MYRA SARGENT DC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 12/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1380 CLEVELAND AVENUE MAIN STREET CLINIC
EAST POINT GA
30344-6959
US

IV. Provider business mailing address

4203 TERRACE CT
SMYRNA GA
30082
US

V. Phone/Fax

Practice location:
  • Phone: 404-765-0021
  • Fax: 404-765-0323
Mailing address:
  • Phone: 404-765-0021
  • Fax: 404-765-0323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. J MYRA SARGENT
Title or Position: PRESIDENT
Credential: DC PC
Phone: 404-765-0021