Provider Demographics
NPI:1639239056
Name:DE SOUSA, SANDRA M (DC)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:M
Last Name:DE SOUSA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4327 MUNDY MILL RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:OAKWOOD
Mailing Address - State:GA
Mailing Address - Zip Code:30566-2563
Mailing Address - Country:US
Mailing Address - Phone:770-531-1621
Mailing Address - Fax:770-531-1691
Practice Address - Street 1:4327 MUNDY MILL RD
Practice Address - Street 2:SUITE A
Practice Address - City:OAKWOOD
Practice Address - State:GA
Practice Address - Zip Code:30566-2563
Practice Address - Country:US
Practice Address - Phone:770-531-1621
Practice Address - Fax:770-531-1691
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR007124111NX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0100XChiropractic ProvidersChiropractorOccupational Health