Provider Demographics
NPI:1205001070
Name:PAUL M. SERGENT M.D. P.C.
Entity Type:Organization
Organization Name:PAUL M. SERGENT M.D. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:MONTFORD
Authorized Official - Last Name:SERGENT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-335-2100
Mailing Address - Street 1:701 HOSPITAL RD
Mailing Address - Street 2:
Mailing Address - City:COMMERCE
Mailing Address - State:GA
Mailing Address - Zip Code:30529
Mailing Address - Country:US
Mailing Address - Phone:706-335-2100
Mailing Address - Fax:706-335-9482
Practice Address - Street 1:701 HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:COMMERCE
Practice Address - State:GA
Practice Address - Zip Code:30529-1166
Practice Address - Country:US
Practice Address - Phone:706-335-2100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-23
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAD30773Medicare UPIN