Healthcare Provider Details

I. General information

NPI: 1003540634
Provider Name (Legal Business Name): SARA HEINZ PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2022
Last Update Date: 01/15/2025
Certification Date: 01/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 N ELAM AVE
GREENSBORO NC
27403-1127
US

IV. Provider business mailing address

520 N ELAM AVE
GREENSBORO NC
27403-1127
US

V. Phone/Fax

Practice location:
  • Phone: 336-547-1745
  • Fax:
Mailing address:
  • Phone: 336-547-1745
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number001012658
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number11069
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: