Provider Demographics
NPI:1649953241
Name:LONDONO BETANCOURT, SARA (RN)
Entity type:Individual
Prefix:MS
First Name:SARA
Middle Name:
Last Name:LONDONO BETANCOURT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 OLD PEACHTREE RD NE
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043-2340
Mailing Address - Country:US
Mailing Address - Phone:404-563-2305
Mailing Address - Fax:
Practice Address - Street 1:705 JUNIPER ST NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30308-1307
Practice Address - Country:US
Practice Address - Phone:404-873-2871
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-09
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA320679163WC1500X, 163WC1600X, 163WG0000X, 163WM0705X, 163WR0400X, 163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No163WC1600XNursing Service ProvidersRegistered NurseContinuing Education/Staff Development
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical
No163WR0400XNursing Service ProvidersRegistered NurseRehabilitation