Healthcare Provider Details

I. General information

NPI: 1861986051
Provider Name (Legal Business Name): SARA DOREEN GRANDY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2018
Last Update Date: 06/19/2025
Certification Date: 06/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9052 HIGHWAY 165 N
STERLINGTON LA
71280-3312
US

IV. Provider business mailing address

5959 S SHERWOOD FOREST BLVD
BATON ROUGE LA
70816-6038
US

V. Phone/Fax

Practice location:
  • Phone: 318-966-8800
  • Fax: 318-966-8801
Mailing address:
  • Phone: 318-966-8800
  • Fax: 225-765-9196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number329015
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: