Provider Demographics
NPI:1952958787
Name:SANDIFORD, LELA (ARNP)
Entity Type:Individual
Prefix:
First Name:LELA
Middle Name:
Last Name:SANDIFORD
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2738 ROLLING DOWNS WAY
Mailing Address - Street 2:
Mailing Address - City:LOGANVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30052-7924
Mailing Address - Country:US
Mailing Address - Phone:407-580-7176
Mailing Address - Fax:
Practice Address - Street 1:5910 SUWANEE DAM RD STE 200
Practice Address - Street 2:
Practice Address - City:SUGAR HILL
Practice Address - State:GA
Practice Address - Zip Code:30518-5648
Practice Address - Country:US
Practice Address - Phone:678-714-3053
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-26
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN238393363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health