Provider Demographics
NPI:1619043650
Name:BOTTS, SABRINA JACKSON (MMSC, PA-C)
Entity Type:Individual
Prefix:MS
First Name:SABRINA
Middle Name:JACKSON
Last Name:BOTTS
Suffix:
Gender:F
Credentials:MMSC, PA-C
Other - Prefix:
Other - First Name:SABRINA
Other - Middle Name:YVETTE
Other - Last Name:JACKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5310 KIRK DR
Mailing Address - Street 2:
Mailing Address - City:COLLEGE PARK
Mailing Address - State:GA
Mailing Address - Zip Code:30349-5800
Mailing Address - Country:US
Mailing Address - Phone:770-907-5832
Mailing Address - Fax:
Practice Address - Street 1:2325 ROSWELL RD
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-4782
Practice Address - Country:US
Practice Address - Phone:470-601-7810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA3103363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical