Healthcare Provider Details

I. General information

NPI: 1548505977
Provider Name (Legal Business Name): SARAH KAY MABINI PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2012
Last Update Date: 12/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3702 2ND AVE
COLUMBUS GA
31904-7408
US

IV. Provider business mailing address

PO BOX 1491
COLUMBUS GA
31902-1491
US

V. Phone/Fax

Practice location:
  • Phone: 706-507-9209
  • Fax: 706-507-9249
Mailing address:
  • Phone: 706-507-9209
  • Fax: 706-507-9249

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number006675
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-03274
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: