Provider Demographics
NPI:1760878854
Name:KOUMTOUZOUA, SARAH HENN (MD)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:HENN
Last Name:KOUMTOUZOUA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:REBECCA
Other - Last Name:HENN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:100 WOODRUFF CIR NE
Mailing Address - Street 2:SUITE 327
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30322-1020
Mailing Address - Country:US
Mailing Address - Phone:404-727-5658
Mailing Address - Fax:
Practice Address - Street 1:100 WOODRUFF CIR NE
Practice Address - Street 2:SUITE 327
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322-1020
Practice Address - Country:US
Practice Address - Phone:404-727-5658
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-15
Last Update Date:2018-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA79747207R00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program