Provider Demographics
NPI:1215435433
Name:DE SAUSSURE, STARLA LEWIS
Entity type:Individual
Prefix:
First Name:STARLA
Middle Name:LEWIS
Last Name:DE SAUSSURE
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 1:3629 GENTIAN BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31907-5675
Mailing Address - Country:US
Mailing Address - Phone:706-221-0887
Mailing Address - Fax:
Practice Address - Street 1:3604 SAINT MARYS RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31906-4510
Practice Address - Country:US
Practice Address - Phone:404-437-3356
Practice Address - Fax:706-243-4900
Is Sole Proprietor?:No
Enumeration Date:2018-01-23
Last Update Date:2018-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator