Provider Demographics
NPI:1073196093
Name:WILLIFORD, SARAH ANN STEVENSON (OD)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:ANN STEVENSON
Last Name:WILLIFORD
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-3328
Mailing Address - Country:US
Mailing Address - Phone:404-378-3694
Mailing Address - Fax:404-372-0741
Practice Address - Street 1:216 CHURCH ST
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-3328
Practice Address - Country:US
Practice Address - Phone:404-378-3694
Practice Address - Fax:404-372-0741
Is Sole Proprietor?:No
Enumeration Date:2021-04-29
Last Update Date:2023-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS-E86152W00000X
GAOPT003483152W00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program