Provider Demographics
NPI:1447709217
Name:MILTON, SANDETTE
Entity type:Individual
Prefix:
First Name:SANDETTE
Middle Name:
Last Name:MILTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1493 SHANNA DR
Mailing Address - Street 2:
Mailing Address - City:TIFTON
Mailing Address - State:GA
Mailing Address - Zip Code:31794-9504
Mailing Address - Country:US
Mailing Address - Phone:229-848-4129
Mailing Address - Fax:229-386-8523
Practice Address - Street 1:1493 SHANNA DR
Practice Address - Street 2:
Practice Address - City:TIFTON
Practice Address - State:GA
Practice Address - Zip Code:31794-9504
Practice Address - Country:US
Practice Address - Phone:229-848-4129
Practice Address - Fax:229-386-8523
Is Sole Proprietor?:No
Enumeration Date:2016-09-22
Last Update Date:2016-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA051259702171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor