Provider Demographics
NPI:1033836721
Name:STARGILL, LEWIS ANTRON
Entity Type:Individual
Prefix:
First Name:LEWIS
Middle Name:ANTRON
Last Name:STARGILL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:182 BARKLEY ST
Mailing Address - Street 2:
Mailing Address - City:PRATTVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36066-1972
Mailing Address - Country:US
Mailing Address - Phone:706-333-4707
Mailing Address - Fax:
Practice Address - Street 1:4607 S COURT ST STE B
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36105-3403
Practice Address - Country:US
Practice Address - Phone:205-675-0566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-24
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
172A00000X
AL343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No172A00000XOther Service ProvidersDriver