1548776586 NPI number — SOPHIA KOUROS SARRIS RN, BSN, IBCLC

Table of content: SOPHIA KOUROS SARRIS RN, BSN, IBCLC (NPI 1548776586)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548776586 NPI number — SOPHIA KOUROS SARRIS RN, BSN, IBCLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SARRIS
Provider First Name:
SOPHIA
Provider Middle Name:
KOUROS
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RN, BSN, IBCLC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SARRIS
Provider Other First Name:
SOPHIA
Provider Other Middle Name:
KATINA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN, BSN, IBCLC
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1548776586
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/18/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2775 NORTHBROOK DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30340-4923
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-449-5955
Provider Business Mailing Address Fax Number:
833-269-3532

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
235 E PONCE DE LEON AVE STE 345
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DECATUR
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30030-5801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-449-5595
Provider Business Practice Location Address Fax Number:
833-269-3532
Provider Enumeration Date:
12/27/2017

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163WL0100X , with the licence number:  102442 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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