Provider Demographics
NPI:1417479940
Name:GEORGIA, SARAH JANE (NP)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:JANE
Last Name:GEORGIA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:JANE
Other - Last Name:KENNEDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:165 CAMBRIDGE ST STE 301
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-2751
Mailing Address - Country:US
Mailing Address - Phone:617-726-5277
Mailing Address - Fax:617-724-8652
Practice Address - Street 1:165 CAMBRIDGE ST STE 301
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2751
Practice Address - Country:US
Practice Address - Phone:617-726-5277
Practice Address - Fax:617-724-8652
Is Sole Proprietor?:No
Enumeration Date:2017-07-17
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN1020059363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health