Healthcare Provider Details

I. General information

NPI: 1932775509
Provider Name (Legal Business Name): SARAH ANNE LUCKEY CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2021
Last Update Date: 03/06/2026
Certification Date: 03/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3651 WHEELER RD
AUGUSTA GA
30909-6521
US

IV. Provider business mailing address

356 EDISTO DR
NORTH AUGUSTA SC
29841-2724
US

V. Phone/Fax

Practice location:
  • Phone: 844-810-4299
  • Fax:
Mailing address:
  • Phone: 803-645-4615
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN-CRNA216717
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: