Individual
MRS. PHYLLIS WRENN SACKARIASEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
3090 SUGAR VALLEY RD NW, SUGAR VALLEY, GA 30746-5166
(706) 624-4661
(706) 624-4698
Mailing address
3090 SUGAR VALLEY RD NW, SUGAR VALLEY, GA 30746-5166
(706) 624-4661
(706) 624-4698
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
002147
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
236050967A
—
GA
Enumeration date
10/10/2005
Last updated
03/07/2023
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