Provider Demographics
NPI:1902196553
Name:JACOBSEN, SARA SUSAN (MD)
Entity Type:Individual
Prefix:DR
First Name:SARA
Middle Name:SUSAN
Last Name:JACOBSEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:595 HURRICANE SHOALS ROAD NW
Mailing Address - Street 2:SUITE 300
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046
Mailing Address - Country:US
Mailing Address - Phone:770-995-0823
Mailing Address - Fax:770-995-7018
Practice Address - Street 1:595 HURRICANE SHOALS ROAD NW
Practice Address - Street 2:SUITE 300
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046
Practice Address - Country:US
Practice Address - Phone:770-995-0823
Practice Address - Fax:770-995-7018
Is Sole Proprietor?:No
Enumeration Date:2011-04-17
Last Update Date:2020-02-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA72284208000000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics