Provider Demographics
NPI:1871398859
Name:SIDMAN, SOPHIE AMELIA (FNP)
Entity type:Individual
Prefix:
First Name:SOPHIE
Middle Name:AMELIA
Last Name:SIDMAN
Suffix:
Gender:
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1295 E ROCK SPRINGS RD NE APT 403
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30306-2341
Mailing Address - Country:US
Mailing Address - Phone:404-984-1363
Mailing Address - Fax:
Practice Address - Street 1:4800 OLDE TOWNE PKWY # 320
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30068-4357
Practice Address - Country:US
Practice Address - Phone:678-341-6370
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-14
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN323929363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care