Healthcare Provider Details

I. General information

NPI: 1609220565
Provider Name (Legal Business Name): SARAH TWEDDELL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2016
Last Update Date: 12/11/2022
Certification Date: 12/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2015 UPPERGATE DRIVE 3RD FLOOR
ATLANTA GA
30322-0001
US

IV. Provider business mailing address

2015 UPPERGATE DRIVE 3RD FLOOR
ATLANTA GA
30322-0001
US

V. Phone/Fax

Practice location:
  • Phone: 414-727-5765
  • Fax: 404-727-3236
Mailing address:
  • Phone: 414-727-5765
  • Fax: 404-727-3236

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number83257
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number12821391-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: