Healthcare Provider Details

I. General information

NPI: 1073196093
Provider Name (Legal Business Name): SARAH ANN STEVENSON WILLIFORD OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2021
Last Update Date: 01/08/2023
Certification Date: 01/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 CHURCH ST
DECATUR GA
30030-3328
US

IV. Provider business mailing address

216 CHURCH ST
DECATUR GA
30030-3328
US

V. Phone/Fax

Practice location:
  • Phone: 404-378-3694
  • Fax: 404-372-0741
Mailing address:
  • Phone: 404-378-3694
  • Fax: 404-372-0741

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberS-E86
License Number StateAL
# 3
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT003483
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: