Provider Demographics
NPI:1275678054
Name:SANFORD, OLA BETH (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:OLA
Middle Name:BETH
Last Name:SANFORD
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:MS
Other - First Name:OLA
Other - Middle Name:BETH
Other - Last Name:KORAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP-C
Mailing Address - Street 1:1835 SAVOY DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30341-1072
Mailing Address - Country:US
Mailing Address - Phone:770-590-8311
Mailing Address - Fax:770-590-8313
Practice Address - Street 1:960 JOHNSON FERRY RD STE 130
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1601
Practice Address - Country:US
Practice Address - Phone:404-300-2990
Practice Address - Fax:404-300-2986
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2020-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN084872363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA810766655IMedicaid
GA810766655JMedicaid
GA810766655JMedicaid