Provider Demographics
NPI:1154554723
Name:POLLY, SANLINA ANN (PCT,CMA)
Entity type:Individual
Prefix:
First Name:SANLINA
Middle Name:ANN
Last Name:POLLY
Suffix:
Gender:F
Credentials:PCT,CMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:466 GREGORY LN APT 106
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30102-7533
Mailing Address - Country:US
Mailing Address - Phone:770-591-8238
Mailing Address - Fax:
Practice Address - Street 1:466 GREGORY LN APT 106
Practice Address - Street 2:
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30102-7533
Practice Address - Country:US
Practice Address - Phone:770-591-8238
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-31
Last Update Date:2009-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1077-04373747P1801X
GA23297376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No376K00000XNursing Service Related ProvidersNurse's Aide