MEDICARE: SARAH SHEALY 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	363AM0700X	Medical Physician Assistant	12382	GA

General Provider Information

NPI Number	:	1497597447
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH SHEALY PA-C

Provider Business Mailing Address
First Line	:	1604 12TH ST
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31906-2938
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1604 12TH ST
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31906-2938
Country	:	US
Telephone Number	:	706-324-0471
Fax Number	:

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

Provider Enumeration Date	:	06/11/2024
Last Update Date	:	06/11/2024

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Directions to “ SARAH SHEALY PA-C” Practice Location

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