Healthcare Provider Details

I. General information

NPI: 1659240752
Provider Name (Legal Business Name): SAMPLE SENT SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2025
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

665 VILLA ESTA AVE
MACON GA
31206-1749
US

IV. Provider business mailing address

665 VILLA ESTA AVE
MACON GA
31206-1749
US

V. Phone/Fax

Practice location:
  • Phone: 478-203-2010
  • Fax: 404-521-4597
Mailing address:
  • Phone: 478-203-2010
  • Fax: 404-521-4597

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: MS. KISA SHRAY TINSLEY
Title or Position: OWNER
Credential:
Phone: 478-203-2010