Provider Demographics
NPI:1174512750
Name:SGJ & P INC
Entity type:Organization
Organization Name:SGJ & P INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:FUSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-597-7822
Mailing Address - Street 1:P. O. BOX 299
Mailing Address - Street 2:
Mailing Address - City:SMITHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37166-1118
Mailing Address - Country:US
Mailing Address - Phone:615-597-7822
Mailing Address - Fax:615-597-1112
Practice Address - Street 1:516-B WEST MAIN STREET
Practice Address - Street 2:
Practice Address - City:SMITHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37166-0299
Practice Address - Country:US
Practice Address - Phone:615-597-7822
Practice Address - Fax:615-597-1112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-17
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail PharmacyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN150553OtherBC/BS
TN4427313OtherNCPDP#
TN3563964OtherTN MEDICAL ASSISTANCE PRO
TN9449808Medicaid
TN3563964OtherTN MEDICAL ASSISTANCE PRO