Provider Demographics
NPI:1306195060
Name:GEORGE, SARA FAITH (RD, CSG, LDN)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:FAITH
Last Name:GEORGE
Suffix:
Gender:F
Credentials:RD, CSG, LDN
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:FAITH
Other - Last Name:SIMMONS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:136 S HAMILTON AVE
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601-2748
Mailing Address - Country:US
Mailing Address - Phone:724-331-5703
Mailing Address - Fax:
Practice Address - Street 1:136 S HAMILTON AVE
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-2748
Practice Address - Country:US
Practice Address - Phone:724-331-5703
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-09
Last Update Date:2012-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN003962133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered