Provider Demographics
NPI:1174988703
Name:LOCKRIDGE, SARAH
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:LOCKRIDGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 KIDSPEACE DR
Mailing Address - Street 2:
Mailing Address - City:BOWDON
Mailing Address - State:GA
Mailing Address - Zip Code:30108-3447
Mailing Address - Country:US
Mailing Address - Phone:770-437-7230
Mailing Address - Fax:
Practice Address - Street 1:101 KIDSPEACE DR
Practice Address - Street 2:
Practice Address - City:BOWDON
Practice Address - State:GA
Practice Address - Zip Code:30108-3447
Practice Address - Country:US
Practice Address - Phone:770-437-7230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-26
Last Update Date:2015-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN235826163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse