Healthcare Provider Details

I. General information

NPI: 1952118465
Provider Name (Legal Business Name): SANDRA DIANE PRESLEY CSFA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2024
Last Update Date: 12/17/2024
Certification Date: 12/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3620 HOWELL FERRY RD
DULUTH GA
30096-3178
US

IV. Provider business mailing address

4980 WEAVER RD
GAINESVILLE GA
30507-8809
US

V. Phone/Fax

Practice location:
  • Phone: 678-312-6800
  • Fax:
Mailing address:
  • Phone: 770-318-8884
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number211665
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: