Provider Demographics
NPI:1962913277
Name:GREGORY, SARAH EMILY (LAT, ATC)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:EMILY
Last Name:GREGORY
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:EMILY
Other - Last Name:MANLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3111 DRUID HILLS RESERVE DR NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30329-2041
Mailing Address - Country:US
Mailing Address - Phone:727-333-0127
Mailing Address - Fax:
Practice Address - Street 1:123 BROAD ST
Practice Address - Street 2:
Practice Address - City:DACULA
Practice Address - State:GA
Practice Address - Zip Code:30019-2199
Practice Address - Country:US
Practice Address - Phone:770-963-6664
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-14
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAT0035922255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer