Provider Demographics
NPI:1437705498
Name:BUTLER, SAMMIE J
Entity Type:Individual
Prefix:
First Name:SAMMIE
Middle Name:J
Last Name:BUTLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 1794
Mailing Address - Street 2:
Mailing Address - City:GARDENDALE
Mailing Address - State:AL
Mailing Address - Zip Code:35071
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5005 SOUTHERLAND RD
Practice Address - Street 2:
Practice Address - City:MT OLIVE
Practice Address - State:AL
Practice Address - Zip Code:35117
Practice Address - Country:US
Practice Address - Phone:205-514-0948
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-15
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider