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General NPI Number Information
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NPI Number | 1245769264
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Entity Type | Individual
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Provider Name | SARA DANIELLE CANNINGTON NP-C
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Gender | Female
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Dates
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Enumeration Date | 06/05/2017
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Last Update Date | 11/03/2020
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Provider Practice Location Address
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Address Line | 1077 S MAIN ST
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City | MADISON
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State | GA
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Zip | 30650-2073
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Country | US
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Telephone | 706-342-1667
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Fax |
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Provider Business Mailing Address
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Address Line | 1584 FOUR LAKES DR
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City | MADISON
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State | GA
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Zip | 30650-4265
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Country | US
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Telephone | 478-279-0352
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Fax |
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN216311
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License Number State | GA
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