Healthcare Provider Details

I. General information

NPI: 1396271755
Provider Name (Legal Business Name): SARAH M BALL P.A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2017
Last Update Date: 09/16/2020
Certification Date: 09/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1255 HIGHWAY 54 W
FAYETTEVILLE GA
30214-4526
US

IV. Provider business mailing address

631 PROFESSIONAL DR STE 200
LAWRENCEVILLE GA
30046-3371
US

V. Phone/Fax

Practice location:
  • Phone: 404-350-0009
  • Fax:
Mailing address:
  • Phone: 678-312-3500
  • Fax: 678-312-3529

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: