Provider Demographics
NPI:1407522501
Name:SPARROW, STANTAFFERTA MCPHEE (PA)
Entity Type:Individual
Prefix:
First Name:STANTAFFERTA
Middle Name:MCPHEE
Last Name:SPARROW
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2365 OLD MILTON PKWY STE 300
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30009-2140
Mailing Address - Country:US
Mailing Address - Phone:770-516-1775
Mailing Address - Fax:770-516-8768
Practice Address - Street 1:1075 LAFAYETTE PKWY STE 200
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:GA
Practice Address - Zip Code:30241-3733
Practice Address - Country:US
Practice Address - Phone:770-740-1860
Practice Address - Fax:770-516-8768
Is Sole Proprietor?:No
Enumeration Date:2021-08-18
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA10522363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant