Provider Demographics
NPI:1912434168
Name:PRESIDENT, SARAH (F1116456)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:PRESIDENT
Suffix:
Gender:F
Credentials:F1116456
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2629 HILDERBRAND DR
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30135-5135
Mailing Address - Country:US
Mailing Address - Phone:770-616-7758
Mailing Address - Fax:770-562-9060
Practice Address - Street 1:1773 SWEETWATER ST
Practice Address - Street 2:
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30106-3294
Practice Address - Country:US
Practice Address - Phone:770-575-4938
Practice Address - Fax:470-588-8862
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-18
Last Update Date:2023-07-17
Deactivation Date:2023-05-21
Deactivation Code:
Reactivation Date:2023-06-12
Provider Licenses
StateLicense IDTaxonomies
GAF1116456363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAF1116456OtherNURSE PRACTITIONERS CERTIFICATION PROGRAM