Provider Demographics
NPI:1437163946
Name:O'HERON, SARA ALLISON (MD)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:ALLISON
Last Name:O'HERON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 GEORGIAN PARK
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269-6972
Mailing Address - Country:US
Mailing Address - Phone:770-631-4873
Mailing Address - Fax:770-631-0684
Practice Address - Street 1:1201 GEORGIAN PARK
Practice Address - Street 2:
Practice Address - City:PEACHTREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30269-6972
Practice Address - Country:US
Practice Address - Phone:770-631-4873
Practice Address - Fax:770-631-0684
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA041632207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000730419ZMedicaid
GA582575461OtherTAX ID NUMBER
GA582575461OtherTAX ID NUMBER
GA08BBTXGMedicare ID - Type Unspecified