Provider Demographics
NPI:1326390741
Name:ECKLEY, SARAH SANDERS (PA)
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:SANDERS
Last Name:ECKLEY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MISS
Other - First Name:SARAH
Other - Middle Name:CAROLINE
Other - Last Name:SANDERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:PO BOX 2344
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30903-2344
Mailing Address - Country:US
Mailing Address - Phone:706-922-0600
Mailing Address - Fax:706-922-0603
Practice Address - Street 1:1226 DANTIGNAC ST
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30901-2788
Practice Address - Country:US
Practice Address - Phone:706-922-0600
Practice Address - Fax:706-922-0603
Is Sole Proprietor?:No
Enumeration Date:2012-10-09
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA006624363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003128677AMedicaid
SC1546PAMedicaid
GA003128677BMedicaid
GA003128677AMedicaid