Provider Demographics
NPI:1023467818
Name:MUN, SARAH ASHLEY (MD)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:ASHLEY
Last Name:MUN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:ASHLEY
Other - Last Name:EDMONSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3970 DEPUTY BILL CANTRELL MEM STE 220
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-3069
Mailing Address - Country:US
Mailing Address - Phone:770-709-6922
Mailing Address - Fax:
Practice Address - Street 1:3970 DEPUTY BILL CANTRELL MEM STE 220
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-3069
Practice Address - Country:US
Practice Address - Phone:770-709-6922
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-13
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60899670207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA96880OtherGA MEDICAL LICENSE