Individual
MS. LISA MARIE SAND
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1655 BERNARDIN AVE STE 350, COLUMBIA, SC 29204-2039
(803) 673-0925
(803) 400-5026
Mailing address
PO BOX 935722, ATLANTA, GA 31193-5722
(843) 792-6200
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
317
SC
363AS0400X
Surgical Physician Assistant
A317
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3015PA
—
SC
01
—
A317
STATE LICENSURE NUMBER
SC
Enumeration date
05/15/2006
Last updated
08/25/2021
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