Healthcare Provider Details

I. General information

NPI: 1538475421
Provider Name (Legal Business Name): JANICE ELIZABETH SANDIFORD NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2010
Last Update Date: 08/18/2020
Certification Date: 08/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5700 HILLANDALE DR STE 250
LITHONIA GA
30058-4120
US

IV. Provider business mailing address

1835 SAVOY DR SUITE 300
ATLANTA GA
30341-1072
US

V. Phone/Fax

Practice location:
  • Phone: 770-981-5431
  • Fax: 770-981-5515
Mailing address:
  • Phone: 770-981-5431
  • Fax: 770-495-2307

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN120356
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: