1902502495 NPI number — MR. KAREEM L SHEGOG M.S, M.P.H. ALC

Table of content: MRS. LEEANN SHEEHY PT (NPI 1003815713)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902502495 NPI number — MR. KAREEM L SHEGOG M.S, M.P.H. ALC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHEGOG
Provider First Name:
KAREEM
Provider Middle Name:
L
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
M.S, M.P.H. ALC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1902502495
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/06/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
54 COUNTRY CLUB LOOP
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WETUMPKA
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36092
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
334-332-3028
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
103 EAST OAK ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TUSKEGEE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36083
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-727-7001
Provider Business Practice Location Address Fax Number:
334-727-0291
Provider Enumeration Date:
02/06/2023

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X , with the licence number:  C21281A , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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