Healthcare Provider Details

I. General information

NPI: 1437580255
Provider Name (Legal Business Name): SALLY LEE ARNOLD APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2013
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 SOUTHFIELD CT
BONAIRE GA
31005-3538
US

IV. Provider business mailing address

201 SOUTHFIELD CT
BONAIRE GA
31005-3538
US

V. Phone/Fax

Practice location:
  • Phone: 478-429-5929
  • Fax: 833-764-6064
Mailing address:
  • Phone: 478-429-5929
  • Fax: 833-764-6064

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN169765
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN169765
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN169765
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: