Healthcare Provider Details

I. General information

NPI: 1558048504
Provider Name (Legal Business Name): SYDNEY LAUREN SNOW AA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2023
Last Update Date: 11/21/2024
Certification Date: 11/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5353 REYNOLDS ST
SAVANNAH GA
31405-6015
US

IV. Provider business mailing address

PO BOX 945375
ATLANTA GA
30394-5375
US

V. Phone/Fax

Practice location:
  • Phone: 516-945-3000
  • Fax: 704-248-5537
Mailing address:
  • Phone: 516-945-3000
  • Fax: 704-248-5537

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License Number12011
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH031556
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: