Provider Demographics
NPI:1578124541
Name:ADAMS, SANDRA LEE (NP)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:LEE
Last Name:ADAMS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MISS
Other - First Name:SANDRA
Other - Middle Name:LYNN
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:1075 LAFAYETTE PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:LAGRANGE
Mailing Address - State:GA
Mailing Address - Zip Code:30241-3507
Mailing Address - Country:US
Mailing Address - Phone:706-443-5273
Mailing Address - Fax:762-323-1014
Practice Address - Street 1:1075 LAFAYETTE PKWY STE 100
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:GA
Practice Address - Zip Code:30241-3507
Practice Address - Country:US
Practice Address - Phone:706-443-5273
Practice Address - Fax:762-323-1014
Is Sole Proprietor?:No
Enumeration Date:2019-06-21
Last Update Date:2019-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GANCO-000008363LA2100X, 363LG0600X
GARN136956363LG0600X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GANCO-000008OtherNP
GARN136956OtherRN