Healthcare Provider Details

I. General information

NPI: 1376046409
Provider Name (Legal Business Name): BRIAN JOSEPH SESTRICH AG-ACNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2018
Last Update Date: 07/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 PEACHTREE STREET
ATLANTA GA
30308
US

IV. Provider business mailing address

550 PEACHTREE STREET-DAVIS FISCHER BUILDING OFFICE 3245A
ATLANTA GA
30308
US

V. Phone/Fax

Practice location:
  • Phone: 404-686-1000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberRN256910
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: