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NPI Code Detail

MEDICARE: SANDY LEEANN MARSHALL RAY CRNA

MEDICARE: SANDY LEEANN MARSHALL RAY CRNA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1367500000XCertified Registered Nurse AnesthetistRN150781GA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1396727087
Entity Type Code : Individual
Provider Name (Legal Business Name) : SANDY LEEANN MARSHALL RAY CRNA
Provider Business Mailing Address
First Line : PO BOX 1950
Second Line :
City : DOUGLASVILLE
State : GA
Zip : 30133-1950
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 8954 HOSPITAL DR
Second Line :
City : DOUGLASVILLE
State : GA
Zip : 30134-2272
Country : US
Telephone Number : 770-920-6413
Fax Number : 678-838-2532
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/17/2005
Last Update Date : 02/18/2010

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