Provider Demographics
NPI:1952118465
Name:PRESLEY, SANDRA DIANE (CSFA)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:DIANE
Last Name:PRESLEY
Suffix:
Gender:F
Credentials:CSFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4980 WEAVER RD
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30507-8809
Mailing Address - Country:US
Mailing Address - Phone:770-318-8884
Mailing Address - Fax:
Practice Address - Street 1:3620 HOWELL FERRY RD
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-3178
Practice Address - Country:US
Practice Address - Phone:678-312-6800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-17
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA211665246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant