Healthcare Provider Details

I. General information

NPI: 1215622634
Provider Name (Legal Business Name): SARAH BREANNE MCGEORGE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2023
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 PROFESSIONAL DR
LONDON KY
40741-8857
US

IV. Provider business mailing address

210 MARIE LANGDON DR
MANCHESTER KY
40962-6388
US

V. Phone/Fax

Practice location:
  • Phone: 606-878-9611
  • Fax:
Mailing address:
  • Phone: 606-598-5104
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number61715
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: