MEDICARE: PAUL M. SERGENT M.D. P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1205001070
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PAUL M. SERGENT M.D. P.C.

Provider Business Mailing Address
First Line	:	701 HOSPITAL RD
Second Line	:
City	:	COMMERCE
State	:	GA
Zip	:	30529
Country	:	US
Telephone Number	:	706-335-2100
Fax Number	:	706-335-9482

Provider Business Practice Location Address
First Line	:	701 HOSPITAL RD
Second Line	:
City	:	COMMERCE
State	:	GA
Zip	:	30529-1166
Country	:	US
Telephone Number	:	706-335-2100
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. PAUL MONTFORD SERGENT
Credential	:	M.D.
Telephone Number	:	706-335-2100

Provider Enumeration Date	:	04/23/2008
Last Update Date	:	04/23/2008

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