Provider Demographics
NPI:1083173736
Name:COLE, SANGAI B (MSW)
Entity Type:Individual
Prefix:
First Name:SANGAI
Middle Name:B
Last Name:COLE
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3051 SHADOW WALK LN
Mailing Address - Street 2:
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-2140
Mailing Address - Country:US
Mailing Address - Phone:678-697-3296
Mailing Address - Fax:
Practice Address - Street 1:3051 SHADOW WALK LN
Practice Address - Street 2:
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-2140
Practice Address - Country:US
Practice Address - Phone:678-697-3296
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-12
Last Update Date:2019-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2019-2331171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor