Provider Demographics
NPI:1376175935
Name:KING, SARA J
Entity Type:Individual
Prefix:MRS
First Name:SARA
Middle Name:J
Last Name:KING
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 1:4106 COLUMBIA RD STE 103
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:GA
Mailing Address - Zip Code:30907-1482
Mailing Address - Country:US
Mailing Address - Phone:706-863-1440
Mailing Address - Fax:706-863-5418
Practice Address - Street 1:4106 COLUMBIA RD STE 103
Practice Address - Street 2:
Practice Address - City:MARTINEZ
Practice Address - State:GA
Practice Address - Zip Code:30907-1482
Practice Address - Country:US
Practice Address - Phone:706-863-1440
Practice Address - Fax:706-863-5418
Is Sole Proprietor?:No
Enumeration Date:2020-02-11
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGAA-NP000434363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics