Healthcare Provider Details

I. General information

NPI: 1053540930
Provider Name (Legal Business Name): GREGORY H SADLER M.ED.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2009
Last Update Date: 07/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 MIZE ST
LA FAYETTE GA
30728-3346
US

IV. Provider business mailing address

501 MIZE ST
LA FAYETTE GA
30728-3346
US

V. Phone/Fax

Practice location:
  • Phone: 706-638-5591
  • Fax: 706-638-2055
Mailing address:
  • Phone: 706-638-5591
  • Fax: 706-638-2055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC005657
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: