Healthcare Provider Details

I. General information

NPI: 1659103695
Provider Name (Legal Business Name): SANDRA ANN ADCOCK FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2024
Last Update Date: 11/25/2025
Certification Date: 11/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39 KENT RD STE 8
TIFTON GA
31794-1697
US

IV. Provider business mailing address

2100 RIVEREDGE PKWY STE 4004TH
ATLANTA GA
30328-4693
US

V. Phone/Fax

Practice location:
  • Phone: 229-391-2910
  • Fax: 229-386-4770
Mailing address:
  • Phone: 229-466-7791
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11034855
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN299106
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: