Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0100X | Occupational Health | CHIR007124 | GA |
NPI | 1639239056 |
---|---|
Provider Name | Dr. Sandra M De Sousa |
First Address | Oakwood, GA 30566-2563 |
Second Address | Oakwood, GA 30566-2563 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/12/2006 |
Last Update Date | 08/07/2007 |