Provider Demographics
NPI:1518021781
Name:WILLARD, SARAH CAMP (MD)
Entity Type:Individual
Prefix:DR
First Name:SARAH
Middle Name:CAMP
Last Name:WILLARD
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 1:2001 LAUREL AVE
Mailing Address - Street 2:STE 204
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37916-1864
Mailing Address - Country:US
Mailing Address - Phone:407-423-5537
Mailing Address - Fax:407-426-0576
Practice Address - Street 1:1802 BELLEVUE AVE
Practice Address - Street 2:SUITE NUMBER 101
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-2933
Practice Address - Country:US
Practice Address - Phone:407-423-5537
Practice Address - Fax:407-426-0576
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME71364208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLBW4641026OtherDEA
FLG08858Medicare UPIN
FLME71364Medicare ID - Type Unspecified