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General NPI Number Information
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NPI Number | 1295149821
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Entity Type | Individual
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Provider Name | NICHOLAS J SACKSTEDER MD
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Gender | Male
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Dates
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Enumeration Date | 06/11/2014
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Last Update Date | 07/15/2021
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Provider Practice Location Address
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Address Line | 1747 BAPTIST CLAY DR STE 200
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City | FLEMING ISLAND
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State | FL
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Zip | 32003-8505
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Country | US
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Telephone | 904-276-5776
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Fax | 904-276-5958
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Provider Business Mailing Address
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Address Line | PO BOX 117345
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City | ATLANTA
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State | GA
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Zip | 30368-7345
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Country | US
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Telephone | 904-346-3465
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Fax | 904-858-6489
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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 | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 27369
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | ME149600
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License Number State | FL
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