Provider Demographics
NPI:1760101083
Name:NUGENT, SARAH DANIELLE (PA-S)
Entity Type:Individual
Prefix:MS
First Name:SARAH
Middle Name:DANIELLE
Last Name:NUGENT
Suffix:
Gender:F
Credentials:PA-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2601 NORTHLAKE DR
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-2942
Mailing Address - Country:US
Mailing Address - Phone:678-255-7581
Mailing Address - Fax:678-255-7548
Practice Address - Street 1:2601 NORTHLAKE DR
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-2942
Practice Address - Country:US
Practice Address - Phone:678-255-7581
Practice Address - Fax:678-255-7548
Is Sole Proprietor?:No
Enumeration Date:2022-08-22
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program