=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487400313
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SANN INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/30/2024
-----------------------------------------------------
Last Update Date | 04/30/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5925 CAVEAT CT
-----------------------------------------------------
City | SUWANEE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30024-4415
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 678-908-1149
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5925 CAVEAT CT
-----------------------------------------------------
City | SUWANEE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30024-4415
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 678-908-1149
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | NOUSHIN VASTANI
-----------------------------------------------------
Credential | NP
-----------------------------------------------------
Telephone | 678-608-1149
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------