Provider Demographics
NPI:1407483076
Name:CONEWAY, SABRINA RENEE
Entity Type:Individual
Prefix:
First Name:SABRINA
Middle Name:RENEE
Last Name:CONEWAY
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 1:3028 ARROWHEAD DR
Mailing Address - Street 2:
Mailing Address - City:LIZELLA
Mailing Address - State:GA
Mailing Address - Zip Code:31052-3512
Mailing Address - Country:US
Mailing Address - Phone:478-960-5114
Mailing Address - Fax:
Practice Address - Street 1:3028 ARROWHEAD DR
Practice Address - Street 2:
Practice Address - City:LIZELLA
Practice Address - State:GA
Practice Address - Zip Code:31052-3512
Practice Address - Country:US
Practice Address - Phone:478-960-5114
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-24
Last Update Date:2020-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA011120101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA0000OtherPRIVATE INSURANCE