Healthcare Provider Details

I. General information

NPI: 1013520170
Provider Name (Legal Business Name): SARA MEJIA MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SARA PARKER MA

II. Dates (important events)

Enumeration Date: 08/28/2020
Last Update Date: 11/17/2023
Certification Date: 11/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

481 ELMA G MILES PKWY STE B
HINESVILLE GA
31313-4004
US

IV. Provider business mailing address

103 W GENERAL SCREVEN WAY STE G PMB 1098
HINESVILLE GA
31313-7462
US

V. Phone/Fax

Practice location:
  • Phone: 912-532-9774
  • Fax: 912-221-3085
Mailing address:
  • Phone: 912-532-9774
  • Fax: 912-221-3085

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-22-61475
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: