=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508928201
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | UVIENOME LINDA SAKOR MD,DNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/16/2006
-----------------------------------------------------
Last Update Date | 03/17/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6559 CHURCH ST STE C
-----------------------------------------------------
City | DOUGLASVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30134-1885
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 678-383-6944
-----------------------------------------------------
Fax | 770-485-0838
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7892 SUNVALLEY LN
-----------------------------------------------------
City | LITHIA SPRINGS
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30122-7816
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 678-383-6944
-----------------------------------------------------
Fax | 770-485-0838
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | RN159225
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 159225
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------