Provider Demographics
NPI:1023040417
Name:DEROSSETT, SARAH ELIZABETH (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:SARAH
Middle Name:ELIZABETH
Last Name:DEROSSETT
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
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Mailing Address - Street 1:2665 N DECATUR RD
Mailing Address - Street 2:STE 630
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-6149
Mailing Address - Country:US
Mailing Address - Phone:404-294-3040
Mailing Address - Fax:404-294-3050
Practice Address - Street 1:2665 N DECATUR RD
Practice Address - Street 2:STE 630
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-6149
Practice Address - Country:US
Practice Address - Phone:404-294-3040
Practice Address - Fax:404-294-3050
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA0348142084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00476352CMedicaid
GA13BDDPGMedicare ID - Type UnspecifiedMEDICARE NUMBER
GA00476352CMedicaid