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General NPI Number Information
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NPI Number | 1457426546
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Entity Type | Individual
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Provider Name | SARA P. RIDDLE NP-C
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Gender | Female
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Dates
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Enumeration Date | 11/22/2006
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Last Update Date | 07/05/2011
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Provider Practice Location Address
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Address Line | 340 KENNESTONE HOSPITAL BLVD SUITE 100
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City | MARIETTA
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State | GA
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Zip | 30060-1152
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Country | US
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Telephone | 770-590-8311
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Fax | 770-590-8313
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Provider Business Mailing Address
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Address Line | 1872 MONTREAL RD
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City | TUCKER
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State | GA
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Zip | 30084-5709
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Country | US
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Telephone | 770-495-3396
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Fax | 770-496-2307
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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 | RN154853
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License Number State | GA
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