Active NPI
Sara Lynn Wedderburn-Maxwell
- Attendant Care Provider
- Acworth, GA
National Provider Identifier
1053900738
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Attendant Care Provider
- License
- 3747A0650X
- Practice address
- 4914 October Way NW
Acworth, GA 30102-7909 - Phone
- (908) 884-5442
- NPI assigned
- Jan 15, 2021
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Attendant Care Provider | 3747A0650X | 3747A0650X | GA | Primary |
Addresses
Primary practice location
4914 October Way NW
Acworth, GA 30102-7909
Mailing address
4914 October Way NW
Acworth, GA 30102-7909
Phone (908) 884-5442
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3747A0650X | GA | MD | Attendant Care Provider |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1610668800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1610668800000",
"number": "1053900738",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4914 OCTOBER WAY NW",
"city": "ACWORTH",
"state": "GA",
"postal_code": "301027909",
"telephone_number": "908-884-5442"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4914 OCTOBER WAY NW",
"city": "ACWORTH",
"state": "GA",
"postal_code": "301027909",
"telephone_number": "908-884-5442"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WEDDERBURN-MAXWELL",
"first_name": "SARA",
"middle_name": "LYNN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-01-15",
"last_updated": "2021-01-15",
"certification_date": "2021-01-15",
"status": "A"
},
"taxonomies": [
{
"code": "3747A0650X",
"taxonomy_group": "",
"desc": "Technician, Attendant Care Provider",
"state": "GA",
"license": "3747A0650X",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Acworth, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.