Healthcare Provider Details

I. General information

NPI: 1033982442
Provider Name (Legal Business Name): SARAH ELIZABETH WISHON PA-C, MMSC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2023
Last Update Date: 11/07/2023
Certification Date: 11/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

939 BOB ARNOLD BLVD STE F
LITHIA SPRINGS GA
30122-3258
US

IV. Provider business mailing address

4243 GLENLAKE PKWY NW
KENNESAW GA
30144-5198
US

V. Phone/Fax

Practice location:
  • Phone: 770-769-1724
  • Fax:
Mailing address:
  • Phone: 770-842-7066
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: