Healthcare Provider Details

I. General information

NPI: 1497985626
Provider Name (Legal Business Name): SARA HEWITT KUPELIAN RN, L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2009
Last Update Date: 04/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6000 LAKE FORREST DR NW SUITE 420
ATLANTA GA
30328-3824
US

IV. Provider business mailing address

6000 LAKE FORREST DR NW SUITE 420
ATLANTA GA
30328-3824
US

V. Phone/Fax

Practice location:
  • Phone: 404-723-9656
  • Fax:
Mailing address:
  • Phone: 404-723-9656
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number201
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: