Provider Demographics
NPI:1730315862
Name:HART, SANDRA KAY (CSA)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:KAY
Last Name:HART
Suffix:
Gender:F
Credentials:CSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1110 GREENWAY ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38701-6437
Mailing Address - Country:US
Mailing Address - Phone:662-332-2421
Mailing Address - Fax:662-332-3032
Practice Address - Street 1:1110 GREENWAY ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MS
Practice Address - Zip Code:38701-6437
Practice Address - Country:US
Practice Address - Phone:662-332-2421
Practice Address - Fax:662-332-3032
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-03
Last Update Date:2009-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant