Provider Demographics
NPI:1760660245
Name:MOYER, SANDRA K (LAC)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:K
Last Name:MOYER
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:K
Other - Last Name:WILDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1200 ARBORHILL LN
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30004-1688
Mailing Address - Country:US
Mailing Address - Phone:678-624-1242
Mailing Address - Fax:
Practice Address - Street 1:1200 ARBORHILL LN
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30004-1688
Practice Address - Country:US
Practice Address - Phone:678-624-1242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-06
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA82171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist