Provider Demographics
NPI:1932119351
Name:JUAREZ, SARA BERTHA (MD)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:BERTHA
Last Name:JUAREZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 CLEVELAND ST
Mailing Address - Street 2:SUITE 350
Mailing Address - City:CROSSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38555-9716
Mailing Address - Country:US
Mailing Address - Phone:931-456-9434
Mailing Address - Fax:931-456-5061
Practice Address - Street 1:1932 ALCOA HWY
Practice Address - Street 2:SUITE 570-C
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37920-1527
Practice Address - Country:US
Practice Address - Phone:865-544-6500
Practice Address - Fax:865-305-6509
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002678207R00000X
TN42649207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
30006051Medicare UPIN