Healthcare Provider Details

I. General information

NPI: 1982558789
Provider Name (Legal Business Name): SARA COULE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1212 AUGUSTA WEST PKWY STE 1B
AUGUSTA GA
30909-1808
US

IV. Provider business mailing address

1212 AUGUSTA WEST PKWY STE 1B
AUGUSTA GA
30909-1808
US

V. Phone/Fax

Practice location:
  • Phone: 706-842-5330
  • Fax: 706-842-5340
Mailing address:
  • Phone: 706-826-2770
  • Fax: 706-826-2771

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-517504
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: