Basic Information
Provider Information | |||||||||
NPI: | 1154618155 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | THURGOOD | ||||||||
FirstName: | SARA | ||||||||
MiddleName: | LINDSEY | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1445 ROSS AVE STE 1400 | ||||||||
Address2: |   | ||||||||
City: | DALLAS | ||||||||
State: | TX | ||||||||
PostalCode: | 752022703 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4698932065 | ||||||||
FaxNumber: | 4698933065 | ||||||||
Practice Location | |||||||||
Address1: | 1115 PAYTON WAY STE 111 | ||||||||
Address2: |   | ||||||||
City: | LEEDS | ||||||||
State: | AL | ||||||||
PostalCode: | 350941135 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2053521175 | ||||||||
FaxNumber: | 2057024833 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/29/2011 | ||||||||
LastUpdateDate: | 12/05/2018 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 36241 | AL | Y |   | Allopathic & Osteopathic Physicians | Family Medicine |   |
No ID Information.