Provider Demographics
NPI:1861946253
Name:KOVACHI, SANDRA (NP)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:KOVACHI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4609 VILLAGE GREEN DR
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-7642
Mailing Address - Country:US
Mailing Address - Phone:770-241-4133
Mailing Address - Fax:
Practice Address - Street 1:4609 VILLAGE GREEN DR
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-7642
Practice Address - Country:US
Practice Address - Phone:770-241-4133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-15
Last Update Date:2019-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP11357363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health