Provider Demographics
NPI:1497140990
Name:GATTIS, SARA BRADEN
Entity Type:Individual
Prefix:MRS
First Name:SARA
Middle Name:BRADEN
Last Name:GATTIS
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 1:109 E BROAD ST
Mailing Address - Street 2:UNIT B
Mailing Address - City:EUFAULA
Mailing Address - State:AL
Mailing Address - Zip Code:36027-2023
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:109 E BROAD ST
Practice Address - Street 2:UNIT B
Practice Address - City:EUFAULA
Practice Address - State:AL
Practice Address - Zip Code:36027-2023
Practice Address - Country:US
Practice Address - Phone:256-468-9031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-01
Last Update Date:2015-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program