Provider Demographics
NPI:1205975521
Name:HARGROVE, ALFONSO G
Entity type:Individual
Prefix:MR
First Name:ALFONSO
Middle Name:G
Last Name:HARGROVE
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 1:620 N ELM ST
Mailing Address - Street 2:SUITE 308-B
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-2020
Mailing Address - Country:US
Mailing Address - Phone:336-988-8908
Mailing Address - Fax:336-889-5854
Practice Address - Street 1:620 N ELM ST
Practice Address - Street 2:SUITE 308-B
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-2020
Practice Address - Country:US
Practice Address - Phone:336-988-8908
Practice Address - Fax:336-889-5854
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6601514251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health