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General NPI Number Information
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NPI Number | 1093506701
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Entity Type | Individual
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Provider Name | SANDRA I AGAZIE, MSN, APRN, PMHNP-BC, CMSRN
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Gender | Female
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Dates
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Enumeration Date | 05/13/2025
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Last Update Date | 10/10/2025
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Provider Practice Location Address
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Address Line | 115 BRADFORD SQ STE B
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City | FAYETTEVILLE
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State | GA
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Zip | 30215-1962
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Country | US
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Telephone | 404-736-4343
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Fax | 844-870-7142
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Provider Business Mailing Address
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Address Line | 7586 OLDHAM LN
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City | RIVERDALE
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State | GA
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Zip | 30274-3595
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Country | US
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Telephone | 404-736-4343
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Fax | 844-270-7142
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WM0705X
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Taxonomy Name | Medical-Surgical Registered Nurse
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License Number | RN170538
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | RN170538
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN170538
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License Number State | GA
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