MEDICARE: MRS. DANIELLE LATRICE SANDS

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
1	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1649151234
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DANIELLE LATRICE SANDS

Provider Business Mailing Address
First Line	:	186 NORTH AVE STE 104
Second Line	:
City	:	JONESBORO
State	:	GA
Zip	:	30236-3292
Country	:	US
Telephone Number	:	470-666-5359
Fax Number	:	470-615-2528

Provider Business Practice Location Address
First Line	:	186 NORTH AVE STE 104
Second Line	:
City	:	JONESBORO
State	:	GA
Zip	:	30236-3292
Country	:	US
Telephone Number	:	470-666-5359
Fax Number	:	470-615-2528

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/10/2025
Last Update Date	:	03/10/2026

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