Healthcare Provider Details

I. General information

NPI: 1801432307
Provider Name (Legal Business Name): SARAH BETH BUSCARINO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2019
Last Update Date: 02/14/2022
Certification Date: 02/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 TEABERRY TRL
DALLAS GA
30132-1153
US

IV. Provider business mailing address

460 REBECCA LN SE
SMYRNA GA
30082-3257
US

V. Phone/Fax

Practice location:
  • Phone: 678-612-4830
  • Fax:
Mailing address:
  • Phone: 678-612-4830
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number209804
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number209804
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: