MEDICARE: MRS. OLA BETH SANFORD NP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	RN084872	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275678054
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. OLA BETH SANFORD NP-C

Provider Business Mailing Address
First Line	:	1835 SAVOY DR
Second Line	:	SUITE 300
City	:	ATLANTA
State	:	GA
Zip	:	30341-1072
Country	:	US
Telephone Number	:	770-590-8311
Fax Number	:	770-590-8313

Provider Business Practice Location Address
First Line	:	960 JOHNSON FERRY RD STE 130
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30342-1601
Country	:	US
Telephone Number	:	404-300-2990
Fax Number	:	404-300-2986

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/20/2007
Last Update Date	:	05/11/2020

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