Provider Demographics
NPI:1821142605
Name:KEY, SALLIE (FNP)
Entity Type:Individual
Prefix:
First Name:SALLIE
Middle Name:
Last Name:KEY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 DOGWOOD HTS
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114-7764
Mailing Address - Country:US
Mailing Address - Phone:770-910-4541
Mailing Address - Fax:770-910-4541
Practice Address - Street 1:301 DOGWOOD HTS STE 200
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-7764
Practice Address - Country:US
Practice Address - Phone:770-910-4541
Practice Address - Fax:770-910-4541
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN0000116942163WG0000X
GARN152212163WG0000X, 363LF0000X
TNAPN0000007667363LF0000X
TX809329363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX311920802Medicaid
TXP01446964OtherRR
TN3908789Medicaid
TX8EH586OtherBCBS
TX311920801Medicaid
TXP01446964OtherRR
TX8EH586OtherBCBS