Provider Demographics
NPI:1801530332
Name:ARTIST, SOPHIA MARIE (RN)
Entity type:Individual
Prefix:
First Name:SOPHIA
Middle Name:MARIE
Last Name:ARTIST
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3424 BAYLOR CIR
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-6157
Mailing Address - Country:US
Mailing Address - Phone:313-742-6780
Mailing Address - Fax:678-519-0645
Practice Address - Street 1:7180 SOUTHLAKE PKWY
Practice Address - Street 2:
Practice Address - City:MORROW
Practice Address - State:GA
Practice Address - Zip Code:30260-4178
Practice Address - Country:US
Practice Address - Phone:770-968-6994
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-21
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN285743163WA2000X, 163WC1500X, 163WC1600X
174200000X, 251S00000X, 261QA0600X, 261QR1300X, 385H00000X, 261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No163WA2000XNursing Service ProvidersRegistered NurseAdministrator
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No163WC1600XNursing Service ProvidersRegistered NurseContinuing Education/Staff Development
No174200000XOther Service ProvidersMeals
No251S00000XAgenciesCommunity/Behavioral Health
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No385H00000XRespite Care FacilityRespite Care