Basic Information
| Provider Information | |||||||||
| NPI: | 1689901639 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HAUPT | ||||||||
| FirstName: | SANDRA | ||||||||
| MiddleName: | HARRISON | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | NP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1191 CRISWELL RD SE | ||||||||
| Address2: | |||||||||
| City: | MONROE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 306556031 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7702678462 | ||||||||
| FaxNumber: | 7704643634 | ||||||||
| Practice Location | |||||||||
| Address1: | 1191 CRISWELL RD SE | ||||||||
| Address2: | |||||||||
| City: | MONROE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 306556031 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7702678462 | ||||||||
| FaxNumber: | 7704643634 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/12/2009 | ||||||||
| LastUpdateDate: | 04/12/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | RN072965 | GA | N | Nursing Service Providers | Registered Nurse | 363LF0000X | RN072965 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.