Provider Demographics
NPI:1336415488
Name:SANDS, LOIS (MA)
Entity Type:Individual
Prefix:MS
First Name:LOIS
Middle Name:
Last Name:SANDS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:925 HILTON ENGLISH RD
Mailing Address - Street 2:
Mailing Address - City:DEMOREST
Mailing Address - State:GA
Mailing Address - Zip Code:30535-2936
Mailing Address - Country:US
Mailing Address - Phone:706-754-1013
Mailing Address - Fax:706-754-1013
Practice Address - Street 1:925 HILTON ENGLISH RD
Practice Address - Street 2:
Practice Address - City:DEMOREST
Practice Address - State:GA
Practice Address - Zip Code:30535-2936
Practice Address - Country:US
Practice Address - Phone:706-754-1013
Practice Address - Fax:706-754-1013
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-22
Last Update Date:2012-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator