Healthcare Provider Details

I. General information

NPI: 1689537839
Provider Name (Legal Business Name): SARAH CANTRELL FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2025
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 MAIN ST
PLAINS GA
31780-5570
US

IV. Provider business mailing address

250 MARTIN LUTHER KING JR BLVD
MACON GA
31201-3490
US

V. Phone/Fax

Practice location:
  • Phone: 229-331-7161
  • Fax:
Mailing address:
  • Phone: 478-301-4111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP004181
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: