Healthcare Provider Details

I. General information

NPI: 1184800534
Provider Name (Legal Business Name): SANJAY SARIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2008
Last Update Date: 05/15/2023
Certification Date: 05/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1267 HIGHWAY 54 W SUITE 2200
FAYETTEVILLE GA
30214-2114
US

IV. Provider business mailing address

1267 HIGHWAY 54 W SUITE 2200
FAYETTEVILLE GA
30214-2114
US

V. Phone/Fax

Practice location:
  • Phone: 770-716-0051
  • Fax: 770-716-0087
Mailing address:
  • Phone: 770-716-0051
  • Fax: 770-716-0087

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number060501
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number060501
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License Number060501
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: