Provider Demographics
NPI:1104589282
Name:HOUSTON, SARA REBEKAH
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:REBEKAH
Last Name:HOUSTON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3957 CLEVELAND HWY STE B
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30721-2052
Mailing Address - Country:US
Mailing Address - Phone:706-852-2374
Mailing Address - Fax:706-852-2375
Practice Address - Street 1:3957 CLEVELAND HWY STE B
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30721-2052
Practice Address - Country:US
Practice Address - Phone:706-852-2374
Practice Address - Fax:706-852-2375
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-15
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN268385363LA2100X
GAF03230054363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care