Healthcare Provider Details

I. General information

NPI: 1245769264
Provider Name (Legal Business Name): SARA DANIELLE CANNINGTON NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DANIELLE ROWE CANNINGTON

II. Dates (important events)

Enumeration Date: 06/05/2017
Last Update Date: 11/03/2020
Certification Date: 11/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1077 S MAIN ST
MADISON GA
30650-2073
US

IV. Provider business mailing address

1584 FOUR LAKES DR
MADISON GA
30650-4265
US

V. Phone/Fax

Practice location:
  • Phone: 706-342-1667
  • Fax:
Mailing address:
  • Phone: 478-279-0352
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN216311
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: