Provider Demographics
NPI:1164916581
Name:SOSEBEE, ANNY (NP-C)
Entity Type:Individual
Prefix:
First Name:ANNY
Middle Name:
Last Name:SOSEBEE
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:147 CRANE MILL RD
Mailing Address - Street 2:
Mailing Address - City:ALTO
Mailing Address - State:GA
Mailing Address - Zip Code:30510-4206
Mailing Address - Country:US
Mailing Address - Phone:706-499-7337
Mailing Address - Fax:
Practice Address - Street 1:396 HISTORIC HWY 441 N
Practice Address - Street 2:
Practice Address - City:DEMOREST
Practice Address - State:GA
Practice Address - Zip Code:30535
Practice Address - Country:US
Practice Address - Phone:706-754-4348
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-19
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN191042363LP0200X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003206458DMedicaid
GA1773728OtherWELLCARE
GA003206458BMedicaid
GA003206458EMedicaid
GA05752404OtherAMERIGROUP
GA1643451OtherWELLCARE
GA1773739OtherWELLCARE
GA003206458AMedicaid
GA003206458CMedicaid
GA1773729OtherWELLCARE
GA1773742OtherWELLCARE