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General NPI Number Information
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NPI Number | 1598120222
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Entity Type | Individual
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Provider Name | SARRAH WIDATALLA
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Gender | Female
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Dates
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Enumeration Date | 12/22/2015
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Last Update Date | 12/22/2015
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Provider Practice Location Address
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Address Line | 944 21ST AVE N APT 802
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City | NASHVILLE
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State | TN
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Zip | 37208-3456
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Country | US
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Telephone | 615-717-4174
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Fax |
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Provider Business Mailing Address
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Address Line | 422 MILLWOOD DR
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City | NASHVILLE
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State | TN
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Zip | 37217-1605
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Country | US
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Telephone | 615-717-4174
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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 | 171WV0202X
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Taxonomy Name | Vehicle Modifications Contractor
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License Number | 190538
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License Number State | TN
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