Provider Demographics
NPI:1932902335
Name:SANFORD, TIMOTHY HOWARD (CARES, CPS-AD)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:HOWARD
Last Name:SANFORD
Suffix:
Gender:M
Credentials:CARES, CPS-AD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 479
Mailing Address - Street 2:
Mailing Address - City:AVONDALE ESTATES
Mailing Address - State:GA
Mailing Address - Zip Code:30002-0479
Mailing Address - Country:US
Mailing Address - Phone:404-289-0313
Mailing Address - Fax:
Practice Address - Street 1:1957 LAKESIDE PKWY
Practice Address - Street 2:
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-5881
Practice Address - Country:US
Practice Address - Phone:404-289-0313
Practice Address - Fax:404-289-0314
Is Sole Proprietor?:No
Enumeration Date:2025-03-31
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist