Provider Demographics
NPI:1598214660
Name:BEAUDELAIRE, SARAH ANNE (PA)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:ANNE
Last Name:BEAUDELAIRE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 749306
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-9306
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2836 AUGUSTA RD
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29170-3323
Practice Address - Country:US
Practice Address - Phone:803-939-0545
Practice Address - Fax:803-939-0583
Is Sole Proprietor?:No
Enumeration Date:2016-09-29
Last Update Date:2024-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC0010-08648363A00000X
NC0010-08648363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant