Healthcare Provider Details

I. General information

NPI: 1891400545
Provider Name (Legal Business Name): SAGE WALTON REUSCH GEHER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2023
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 EASTOWNE DR
CHAPEL HILL NC
27514-2286
US

IV. Provider business mailing address

648 N EAST CAPITOL BLVD
SALT LAKE CITY UT
84103-2139
US

V. Phone/Fax

Practice location:
  • Phone: 984-974-4462
  • Fax:
Mailing address:
  • Phone: 801-879-3016
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: