Healthcare Provider Details

I. General information

NPI: 1770517336
Provider Name (Legal Business Name): SABRA ELIZABETH LOWE L.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 04/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

918 S BROAD ST
THOMASVILLE GA
31792-6198
US

IV. Provider business mailing address

918 S BROAD ST
THOMASVILLE GA
31792-6198
US

V. Phone/Fax

Practice location:
  • Phone: 229-226-8800
  • Fax: 229-226-8232
Mailing address:
  • Phone: 229-226-8800
  • Fax: 229-226-8232

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberLD002499
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberND6488
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: