Provider Demographics
NPI:1508196700
Name:GORGOR, SAYE
Entity Type:Individual
Prefix:
First Name:SAYE
Middle Name:
Last Name:GORGOR
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 1:4165 30TH AVE S STE 101
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-8419
Mailing Address - Country:US
Mailing Address - Phone:866-825-3227
Mailing Address - Fax:866-397-7399
Practice Address - Street 1:9465 HIGHWAY 5
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30135-1509
Practice Address - Country:US
Practice Address - Phone:866-825-3227
Practice Address - Fax:866-397-7399
Is Sole Proprietor?:No
Enumeration Date:2010-01-11
Last Update Date:2010-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN105044363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily