Provider Demographics
NPI:1902455322
Name:SAWYERS, SAMMY MANDELL JR
Entity Type:Individual
Prefix:
First Name:SAMMY
Middle Name:MANDELL
Last Name:SAWYERS
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 BODAFORD RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HILL
Mailing Address - State:GA
Mailing Address - Zip Code:31324-5025
Mailing Address - Country:US
Mailing Address - Phone:912-432-1932
Mailing Address - Fax:
Practice Address - Street 1:555 BODAFORD RD
Practice Address - Street 2:
Practice Address - City:RICHMOND HILL
Practice Address - State:GA
Practice Address - Zip Code:31324-5025
Practice Address - Country:US
Practice Address - Phone:912-432-1932
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-09
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider