MEDICARE: SARA ANN TRIVETTE PA-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	363A00000X	Physician Assistant	004819	GA
2	363AM0700X	Medical Physician Assistant	004819	GA

General Provider Information

NPI Number	:	1427083070
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARA ANN TRIVETTE PA-C

Provider Business Mailing Address
First Line	:	204 N WESTOVER BLVD
Second Line	:	ALBANY
City	:	ALBANY
State	:	GA
Zip	:	31707-2983
Country	:	US
Telephone Number	:	229-888-6559
Fax Number	:	229-436-4107

Provider Business Practice Location Address
First Line	:	2001 LEONARD AVE
Second Line	:
City	:	ALBANY
State	:	GA
Zip	:	31705-2341
Country	:	US
Telephone Number	:	229-435-9934
Fax Number	:

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

Provider Enumeration Date	:	07/12/2006
Last Update Date	:	11/21/2013

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Directions to “ SARA ANN TRIVETTE PA-C” Practice Location

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