Provider Demographics
NPI:1336687896
Name:SAGE MEDICAL, PLLC
Entity Type:Organization
Organization Name:SAGE MEDICAL, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:OLUGBEMIGA
Authorized Official - Middle Name:E
Authorized Official - Last Name:JEGEDE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:810-908-9996
Mailing Address - Street 1:150 COBBLESTONE WALK
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27455-8420
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:150 COBBLESTONE WALK
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27455-8420
Practice Address - Country:US
Practice Address - Phone:810-908-9996
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-05
Last Update Date:2017-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC211390208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty