Provider Demographics
NPI:1639803604
Name:CUBAS, SARAH
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:CUBAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5667 PEACHTREE DUNWOODY RD STE 260
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1714
Mailing Address - Country:US
Mailing Address - Phone:404-255-1030
Mailing Address - Fax:678-843-6619
Practice Address - Street 1:5667 PEACHTREE DUNWOODY RD STE 260
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1714
Practice Address - Country:US
Practice Address - Phone:404-255-1030
Practice Address - Fax:678-843-6619
Is Sole Proprietor?:No
Enumeration Date:2022-07-14
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN264609163W00000X, 363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003279620AMedicaid