Healthcare Provider Details

I. General information

NPI: 1184203549
Provider Name (Legal Business Name): SARAH BROWN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2021
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 WOODCHASE WAY
WOODSTOCK GA
30188-2052
US

IV. Provider business mailing address

403 WOODCHASE WAY
WOODSTOCK GA
30188-2052
US

V. Phone/Fax

Practice location:
  • Phone: 678-956-1272
  • Fax:
Mailing address:
  • Phone: 678-956-1272
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License Number2026046136
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: