Provider Demographics
NPI:1194228767
Name:WILBRANDT, SARAH STEPHENS (PA)
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:STEPHENS
Last Name:WILBRANDT
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MS
Other - First Name:SARAH
Other - Middle Name:
Other - Last Name:STEPHENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:200 CORPORATE BLVD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-3870
Mailing Address - Country:US
Mailing Address - Phone:800-893-9698
Mailing Address - Fax:
Practice Address - Street 1:745 POPLAR RD
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-1618
Practice Address - Country:US
Practice Address - Phone:770-253-1912
Practice Address - Fax:770-253-8845
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-09
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPA.1334363A00000X
GA9239363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant