Provider Demographics
NPI:1881649408
Name:BECK, SARA M (PA-C)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:M
Last Name:BECK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 BALD RIDGE MARINA RD
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-8494
Mailing Address - Country:US
Mailing Address - Phone:770-886-0003
Mailing Address - Fax:770-886-5030
Practice Address - Street 1:1200 BALD RIDGE MARINA RD
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-8494
Practice Address - Country:US
Practice Address - Phone:770-886-0003
Practice Address - Fax:770-886-5030
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA03999363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P99313Medicare UPIN
97WCGDNMedicare ID - Type Unspecified