Provider Demographics
NPI:1548776586
Name:SARRIS, SOPHIA KOUROS (RN, BSN, IBCLC)
Entity type:Individual
Prefix:
First Name:SOPHIA
Middle Name:KOUROS
Last Name:SARRIS
Suffix:
Gender:F
Credentials:RN, BSN, IBCLC
Other - Prefix:
Other - First Name:SOPHIA
Other - Middle Name:KATINA
Other - Last Name:SARRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, BSN, IBCLC
Mailing Address - Street 1:2775 NORTHBROOK DR
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30340-4923
Mailing Address - Country:US
Mailing Address - Phone:404-449-5955
Mailing Address - Fax:833-269-3532
Practice Address - Street 1:1285 HEMBREE RD STE 100
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-5715
Practice Address - Country:US
Practice Address - Phone:404-449-5955
Practice Address - Fax:833-269-3532
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-27
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA102442163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant