Basic Information
Provider Information
NPI: 1912294224
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GRABMILLER
FirstName: SARAH
MiddleName: A
NamePrefix: DR.
NameSuffix:  
Credential: DO
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 5183
Address2:  
City: MERIDIAN
State: MS
PostalCode: 393025183
CountryCode: US
TelephoneNumber: 6017034282
FaxNumber: 6017034597
Practice Location
Address1: 1800 12TH ST
Address2:  
City: MERIDIAN
State: MS
PostalCode: 393014158
CountryCode: US
TelephoneNumber: 6017039265
FaxNumber: 6017033224
Other Information
ProviderEnumerationDate: 07/07/2011
LastUpdateDate: 04/13/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207Q00000XT2436MSY Allopathic & Osteopathic PhysiciansFamily Medicine 

No ID Information.


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