Provider Demographics
NPI:1457238198
Name:MCMULLIN, SANDI SIERRA
Entity type:Individual
Prefix:
First Name:SANDI
Middle Name:SIERRA
Last Name:MCMULLIN
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 1:119 EMILY LN SW
Mailing Address - Street 2:
Mailing Address - City:ADAIRSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30103-3644
Mailing Address - Country:US
Mailing Address - Phone:762-204-9691
Mailing Address - Fax:
Practice Address - Street 1:3150 COBB PKWY NW STE 150
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30152-1009
Practice Address - Country:US
Practice Address - Phone:678-574-6868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-15
Last Update Date:2025-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist