MEDICARE: SARA ELIZABETH DOVER PA-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	363A00000X	Physician Assistant	10433	GA

General Provider Information

NPI Number	:	1386285914
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARA ELIZABETH DOVER PA-C

Provider Business Mailing Address
First Line	:	931 PONCE DE LEON AVE NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30306-4211
Country	:	US
Telephone Number	:	678-379-9576
Fax Number	:	678-904-1406

Provider Business Practice Location Address
First Line	:	931 PONCE DE LEON AVE NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30306-4211
Country	:	US
Telephone Number	:	404-376-5574
Fax Number	:

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

Provider Enumeration Date	:	10/04/2019
Last Update Date	:	06/11/2026

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