Provider Demographics
NPI:1629609193
Name:SAGL
Entity Type:Organization
Organization Name:SAGL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:L
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-400-0498
Mailing Address - Street 1:2807 US HIGHWAY 84 E
Mailing Address - Street 2:
Mailing Address - City:CAIRO
Mailing Address - State:GA
Mailing Address - Zip Code:39828-1371
Mailing Address - Country:US
Mailing Address - Phone:229-377-9064
Mailing Address - Fax:229-377-3926
Practice Address - Street 1:2807 US HIGHWAY 84 E
Practice Address - Street 2:
Practice Address - City:CAIRO
Practice Address - State:GA
Practice Address - Zip Code:39828-1371
Practice Address - Country:US
Practice Address - Phone:229-377-9064
Practice Address - Fax:229-377-3926
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-03
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty