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General NPI Number Information
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NPI Number | 1649129511
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Entity Type | Organization
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Legal Business Name | SAGAR SERENE
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Dates
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Enumeration Date | 01/24/2026
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Last Update Date | 01/24/2026
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Provider Practice Location Address
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Address Line | 603 POST KNL
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City | GRIFFIN
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State | GA
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Zip | 30224-4570
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Country | US
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Telephone | 520-678-2292
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Fax | 520-678-2292
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Provider Business Mailing Address
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Address Line | 603 POST KNL
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City | GRIFFIN
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State | GA
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Zip | 30224-4570
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Country | US
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Telephone | 520-678-2292
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Fax | 520-678-2292
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Authorized Official
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Title or Position | AUTHORIZED USER
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Name | MR. CARL D NELSON JR.
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Credential |
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Telephone | 520-678-2292
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number |
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License Number State |
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