Provider Demographics
NPI:1689072746
Name:ANDERSON, SACOIA TRAINS (LPN)
Entity Type:Individual
Prefix:MS
First Name:SACOIA
Middle Name:TRAINS
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1860 NEIGHBORHOOD WALK
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30252-8643
Mailing Address - Country:US
Mailing Address - Phone:478-919-3889
Mailing Address - Fax:
Practice Address - Street 1:1860 NEIGHBORHOOD WALK
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30252-8643
Practice Address - Country:US
Practice Address - Phone:478-919-3889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-05
Last Update Date:2014-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPN074887164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
GALPN074887OtherLPN LICENSE