1235136433 NPI number — DR. SARAH W GERMANSON M.D.

Table of content: DR. SARAH W GERMANSON M.D. (NPI 1235136433)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235136433 NPI number — DR. SARAH W GERMANSON M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GERMANSON
Provider First Name:
SARAH
Provider Middle Name:
W
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

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:
1235136433
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/13/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
364 HONEYSUCKLE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DOTHAN
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36305-1140
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
334-794-8656
Provider Business Mailing Address Fax Number:
877-389-4229

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
364 HONEYSUCKLE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DOTHAN
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36305-1140
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-794-8656
Provider Business Practice Location Address Fax Number:
877-389-4229
Provider Enumeration Date:
07/01/2005

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: 208000000X , with the licence number:  24270 , 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)

  • Identifier: 009917275 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 630738893 . This is a "TAX ID" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 392822822A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 272657200 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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