Healthcare Provider Details

I. General information

NPI: 1598634842
Provider Name (Legal Business Name): SARANG PARK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2025
Last Update Date: 01/08/2026
Certification Date: 01/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2780 PEACHTREE INDUSTRIAL BLVD
DULUTH GA
30097-8028
US

IV. Provider business mailing address

1945 SPRING MIST TER
LAWRENCEVILLE GA
30043-6075
US

V. Phone/Fax

Practice location:
  • Phone: 770-906-5393
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN711952
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN711952
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code163WN0002X
TaxonomyNeonatal Intensive Care Registered Nurse
License NumberRN711952
License Number StateGA
# 4
Primary TaxonomyY
Taxonomy Code163WS0121X
TaxonomyPlastic Surgery Registered Nurse
License NumberRN711952
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: