Healthcare Provider Details

I. General information

NPI: 1013305598
Provider Name (Legal Business Name): SARA OLIVER DUPREE L.P.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2015
Last Update Date: 04/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 EBENEZER CHURCH RD STE 110
SHARPSBURG GA
30277-2073
US

IV. Provider business mailing address

26 NICKLAUS WALK
NEWNAN GA
30265-2057
US

V. Phone/Fax

Practice location:
  • Phone: 404-960-1282
  • Fax:
Mailing address:
  • Phone: 770-317-6323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC007730
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: