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General NPI Number Information
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NPI Number | 1215435433
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Entity Type | Individual
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Provider Name | STARLA LEWIS DE SAUSSURE
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Gender | Female
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Dates
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Enumeration Date | 01/23/2018
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Last Update Date | 01/23/2018
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Provider Practice Location Address
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Address Line | 3604 SAINT MARYS RD
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City | COLUMBUS
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State | GA
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Zip | 31906-4510
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Country | US
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Telephone | 404-437-3356
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Fax | 706-243-4900
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Provider Business Mailing Address
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Address Line | 3629 GENTIAN BLVD STE A
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City | COLUMBUS
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State | GA
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Zip | 31907-5675
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Country | US
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Telephone | 706-221-0887
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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