Provider Demographics
NPI:1548817208
Name:SANTIAGO, ARLENE
Entity type:Individual
Prefix:
First Name:ARLENE
Middle Name:
Last Name:SANTIAGO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ARLENE
Other - Middle Name:
Other - Last Name:SANTIAGO-SUTTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:285 BELLA VISTA TER
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-8663
Mailing Address - Country:US
Mailing Address - Phone:678-554-7007
Mailing Address - Fax:
Practice Address - Street 1:6053 JONESBORO RD
Practice Address - Street 2:
Practice Address - City:MORROW
Practice Address - State:GA
Practice Address - Zip Code:30260-1106
Practice Address - Country:US
Practice Address - Phone:770-824-4343
Practice Address - Fax:678-519-1089
Is Sole Proprietor?:No
Enumeration Date:2019-08-19
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN216520363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily