Provider Demographics
NPI:1295324895
Name:GRAVES, SARA WINGATE (FNP-C)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:WINGATE
Last Name:GRAVES
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:
Other - Last Name:WINGATE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:225 S PHILPOT ST
Mailing Address - Street 2:
Mailing Address - City:CEDARTOWN
Mailing Address - State:GA
Mailing Address - Zip Code:30125-3021
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:442-201-0461
Practice Address - Street 1:78 OPAL ST
Practice Address - Street 2:
Practice Address - City:CARTERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30120-2848
Practice Address - Country:US
Practice Address - Phone:770-382-6120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-18
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN31353363LF0000X
GA322814363LF0000X
SC24589363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily