Provider Demographics
NPI:1396714572
Name:CANTRELL, SARAH JANE (NP)
Entity type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:JANE
Last Name:CANTRELL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2168
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30301-2168
Mailing Address - Country:US
Mailing Address - Phone:864-560-4304
Mailing Address - Fax:864-560-4413
Practice Address - Street 1:407 W SOUTH ST
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:SC
Practice Address - Zip Code:29379-2771
Practice Address - Country:US
Practice Address - Phone:864-429-8846
Practice Address - Fax:864-429-9093
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC18953363LF0000X
VA0024118054363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSC4253J577OtherMEDICARE PIN
SCNP2821Medicaid
SCSC4253H895OtherMEDICARE PIN