Provider Demographics
NPI:1891496949
Name:GEORGETOWN, SAUNDRA
Entity Type:Individual
Prefix:MRS
First Name:SAUNDRA
Middle Name:
Last Name:GEORGETOWN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 92
Mailing Address - Street 2:
Mailing Address - City:PLAQUEMINE
Mailing Address - State:LA
Mailing Address - Zip Code:70765-0092
Mailing Address - Country:US
Mailing Address - Phone:225-385-3265
Mailing Address - Fax:
Practice Address - Street 1:59062 NATHAN GEORGETOWN ST
Practice Address - Street 2:
Practice Address - City:PLAQUEMINE
Practice Address - State:LA
Practice Address - Zip Code:70764-3073
Practice Address - Country:US
Practice Address - Phone:225-385-3265
Practice Address - Fax:225-612-6347
Is Sole Proprietor?:No
Enumeration Date:2023-03-15
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator