Provider Demographics
NPI:1245769264
Name:CANNINGTON, SARA DANIELLE (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:SARA
Middle Name:DANIELLE
Last Name:CANNINGTON
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:ROWE
Other - Last Name:CANNINGTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1584 FOUR LAKES DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:GA
Mailing Address - Zip Code:30650-4265
Mailing Address - Country:US
Mailing Address - Phone:478-279-0352
Mailing Address - Fax:
Practice Address - Street 1:1077 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:GA
Practice Address - Zip Code:30650-2073
Practice Address - Country:US
Practice Address - Phone:706-342-1667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-05
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN216311363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily