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NPI Code Detail

MEDICARE: SARAH ANNE BEAUDELAIRE PA

MEDICARE: SARAH ANNE BEAUDELAIRE PA
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
1363A00000XPhysician Assistant0010-08648NC
2363A00000XPhysician Assistant0010-08648SC

General Provider Information

NPI Number : 1598214660
Entity Type Code : Individual
Provider Name (Legal Business Name) : SARAH ANNE BEAUDELAIRE PA
Provider Business Mailing Address
First Line : PO BOX 749306
Second Line :
City : ATLANTA
State : GA
Zip : 30374-9306
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2836 AUGUSTA RD
Second Line :
City : WEST COLUMBIA
State : SC
Zip : 29170-3323
Country : US
Telephone Number : 803-939-0545
Fax Number : 803-939-0583
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/29/2016
Last Update Date : 06/05/2025

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Directions to “ SARAH ANNE BEAUDELAIRE PA” Practice Location

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