Provider Demographics
NPI:1447592712
Name:GULF COAST CANCER CENTER AT BREWTON
Entity Type:Organization
Organization Name:GULF COAST CANCER CENTER AT BREWTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:SAWRIE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:251-948-7897
Mailing Address - Street 1:3330 PRESTON RIDGE RD
Mailing Address - Street 2:300
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-4508
Mailing Address - Country:US
Mailing Address - Phone:770-350-0126
Mailing Address - Fax:770-350-6637
Practice Address - Street 1:1207 AZALEA PL
Practice Address - Street 2:
Practice Address - City:BREWTON
Practice Address - State:AL
Practice Address - Zip Code:36426-1337
Practice Address - Country:US
Practice Address - Phone:251-867-6544
Practice Address - Fax:770-512-8937
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-25
Last Update Date:2013-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty