Individual provider Active NPI

Sandra I Agazie

  • Psychiatric/Mental Health Nurse Practitioner
  • Fayetteville, GA
National Provider Identifier
1093506701
Registry record updated Aug 25, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
RN170528 Issued in GA
Practice address
115 Bradford SQ Ste B
Fayetteville, GA 30215-1962
Phone
(404) 736-4343
Fax
(844) 870-7142
NPI assigned
May 13, 2025
Last updated
Aug 25, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 25, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X RN170528 GA
Adult Health Nurse Practitioner 363LA2200X RN170528 GA
Psychiatric/Mental Health Nurse Practitioner 363LP0808X RN170528 GA Primary
Primary Care Nurse Practitioner 363LP2300X RN170528 GA
Registered Nurse 163W00000X RN170538 GA
Medical-Surgical Registered Nurse 163WM0705X RN170538 GA

Addresses

Primary practice location

115 Bradford SQ Ste B
Fayetteville, GA 30215-1962

Mailing address

7586 Oldham LN
Riverdale, GA 30274-3595
Phone (404) 736-4343

Other identifiers 5

IdentifierTypeStateIssuer
003133861AMedicaidGA
0031333861DMedicaidGA
003133861BMedicaidGA
003315273AMedicaidGA
003149239AMedicaidGA

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

LicenseStateTypeSpecialty
RN170538GAMDMedical-Surgical Registered Nurse
RN170528GAMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Sanzie Healthcare Services, Inc Registered Nurse CurrentSince May 18, 2025 Accepting new patients

Locations

115 Bradford Sq
Ste B
Fayetteville, GA 30215
Phone (404) 736-4343

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1747094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1787616000000",
    "number": "1093506701",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7586 OLDHAM LN",
            "city": "RIVERDALE",
            "state": "GA",
            "postal_code": "302743595",
            "telephone_number": "404-736-4343",
            "fax_number": "844-270-7142"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "115 BRADFORD SQ STE B",
            "city": "FAYETTEVILLE",
            "state": "GA",
            "postal_code": "302151962",
            "telephone_number": "404-736-4343",
            "fax_number": "844-870-7142"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AGAZIE",
        "first_name": "SANDRA",
        "middle_name": "I",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-05-13",
        "last_updated": "2026-08-25",
        "certification_date": "2026-08-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "GA",
            "license": "RN170528",
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "GA",
            "license": "RN170528",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "GA",
            "license": "RN170528",
            "primary": true
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "GA",
            "license": "RN170528",
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "GA",
            "license": "RN170538",
            "primary": false
        },
        {
            "code": "163WM0705X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Medical-Surgical",
            "state": "GA",
            "license": "RN170538",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003133861A",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0031333861D",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003133861B",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003315273A",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003149239A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fayetteville, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.