MEDICARE: MRS. SARAH FORMAN CONKELL FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	RN217084	GA

General Provider Information

NPI Number	:	1346755279
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SARAH FORMAN CONKELL FNP-C

Provider Business Mailing Address
First Line	:	1020 PIEDMONT AVE NE UNIT 1310
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30309-4184
Country	:	US
Telephone Number	:	404-680-9431
Fax Number	:

Provider Business Practice Location Address
First Line	:	20 GLENLAKE PKWY
Second Line	:
City	:	SANDY SPRINGS
State	:	GA
Zip	:	30328-3473
Country	:	US
Telephone Number	:	800-611-1811
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/14/2017
Last Update Date	:	01/10/2022

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