Healthcare Provider Details

I. General information

NPI: 1144761560
Provider Name (Legal Business Name): SARAH N. STREETER-EASON FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2017
Last Update Date: 04/05/2023
Certification Date: 04/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1060 RETNER DR SW
MABLETON GA
30126-1583
US

IV. Provider business mailing address

150 HELMSWOOD CIR SW
MARIETTA GA
30064-5019
US

V. Phone/Fax

Practice location:
  • Phone: 770-710-1487
  • Fax:
Mailing address:
  • Phone: 770-710-1487
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN217548
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: