Provider Demographics
NPI:1528346152
Name:SAWYER, JEWEL (PA)
Entity type:Individual
Prefix:MS
First Name:JEWEL
Middle Name:
Last Name:SAWYER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2140 PEACHTREE RD NW
Mailing Address - Street 2:STE 232
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-1314
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2140 PEACHTREE RD NW
Practice Address - Street 2:STE 232
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-1314
Practice Address - Country:US
Practice Address - Phone:404-231-4431
Practice Address - Fax:404-231-5677
Is Sole Proprietor?:No
Enumeration Date:2011-08-01
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA06190363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00314162BMedicaid