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General NPI Number Information
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NPI Number | 1336637024
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Entity Type | Individual
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Provider Name | SERA GABRIELLE STORY PA-C
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Gender | Female
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Dates
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Enumeration Date | 04/27/2018
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Last Update Date | 12/19/2023
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Provider Practice Location Address
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Address Line | 401 W MAIN ST
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City | SWAINSBORO
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State | GA
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Zip | 30401
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Country | US
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Telephone | 478-237-9928
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Fax |
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Provider Business Mailing Address
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Address Line | 401 W MAIN ST
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City | SWAINSBORO
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State | GA
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Zip | 30401-3110
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Country | US
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Telephone | 478-237-9928
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 008762
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License Number State | GA
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