MEDICARE: SARAH JETHRO DO

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	207Q00000X	Family Medicine Physician	V1500	TX

General Provider Information

NPI Number	:	1831831361
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH JETHRO DO

Provider Business Mailing Address
First Line	:	212 W CAYUGA DR
Second Line	:
City	:	ATHENS
State	:	TX
Zip	:	75751-3204
Country	:	US
Telephone Number	:	903-675-5742
Fax Number	:

Provider Business Practice Location Address
First Line	:	212 W CAYUGA DR
Second Line	:
City	:	ATHENS
State	:	TX
Zip	:	75751-3204
Country	:	US
Telephone Number	:	903-675-5742
Fax Number	:

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

Provider Enumeration Date	:	04/13/2022
Last Update Date	:	02/05/2026

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