Provider Demographics
NPI:1124617022
Name:PERRY, SANDRA EDWARDS
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:EDWARDS
Last Name:PERRY
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 1:815 MORNING GLORY DR
Mailing Address - Street 2:
Mailing Address - City:OPELIKA
Mailing Address - State:AL
Mailing Address - Zip Code:36801-2499
Mailing Address - Country:US
Mailing Address - Phone:205-955-0549
Mailing Address - Fax:
Practice Address - Street 1:815 MORNING GLORY DR
Practice Address - Street 2:
Practice Address - City:OPELIKA
Practice Address - State:AL
Practice Address - Zip Code:36801-2499
Practice Address - Country:US
Practice Address - Phone:205-955-0549
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-14
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program