MEDICARE: SARAH JEAN RHODES PHYSICIAN ASSISTANT

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	5804	GA
2	363AM0700X	Medical Physician Assistant	5804	GA
3	363A00000X	Physician Assistant	005804	GA

General Provider Information

NPI Number	:	1962734046
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH JEAN RHODES PHYSICIAN ASSISTANT

Provider Business Mailing Address
First Line	:	95 COLLIER RD NW STE 4055
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30309-1749
Country	:	US
Telephone Number	:	404-355-3200
Fax Number	:

Provider Business Practice Location Address
First Line	:	95 COLLIER RD NW STE 4055
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30309-1749
Country	:	US
Telephone Number	:	404-355-3200
Fax Number	:

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

Provider Enumeration Date	:	02/01/2010
Last Update Date	:	11/04/2022

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