Provider Demographics
NPI:1659395374
Name:SERGENT, PAUL MONTFORD (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:MONTFORD
Last Name:SERGENT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 HOSPITAL RD
Mailing Address - Street 2:
Mailing Address - City:COMMERCE
Mailing Address - State:GA
Mailing Address - Zip Code:30529-1166
Mailing Address - Country:US
Mailing Address - Phone:706-335-2100
Mailing Address - Fax:706-335-9482
Practice Address - Street 1:701 HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:COMMERCE
Practice Address - State:GA
Practice Address - Zip Code:30529-1166
Practice Address - Country:US
Practice Address - Phone:706-335-2100
Practice Address - Fax:706-335-9482
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA016280207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAD30773Medicare UPIN