Provider Demographics
NPI:1295394237
Name:ESTRADA, SARAH ANNALISE
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:ANNALISE
Last Name:ESTRADA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3224 MERCER UNIVERSITY DR APT 301
Mailing Address - Street 2:
Mailing Address - City:CHAMBLEE
Mailing Address - State:GA
Mailing Address - Zip Code:30341-5666
Mailing Address - Country:US
Mailing Address - Phone:678-551-4508
Mailing Address - Fax:
Practice Address - Street 1:3224 MERCER UNIVERSITY DR APT 301
Practice Address - Street 2:
Practice Address - City:CHAMBLEE
Practice Address - State:GA
Practice Address - Zip Code:30341-5666
Practice Address - Country:US
Practice Address - Phone:678-551-4508
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-12
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA9858363AM0700X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program