Provider Demographics
NPI:1902609217
Name:PETRUCCELLI-BEDGOOD, SARAH G
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:G
Last Name:PETRUCCELLI-BEDGOOD
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:G
Other - Last Name:PETRUCCELLI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CPNP-AC
Mailing Address - Street 1:1143 RAMBLEWOOD DR NE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-5530
Mailing Address - Country:US
Mailing Address - Phone:678-988-9809
Mailing Address - Fax:
Practice Address - Street 1:1001 JOHNSON FY RD NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1605
Practice Address - Country:US
Practice Address - Phone:404-785-5437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-31
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN317760363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics