Basic Information
| Provider Information | |||||||||
| NPI: | 1033754072 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SANDERS | ||||||||
| FirstName: | DAVID | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4235 JOHNS CREEK PKWY STE A | ||||||||
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| City: | SUWANEE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300246038 | ||||||||
| CountryCode: | US | ||||||||
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| Address1: | 4235 JOHNS CREEK PKWY STE A | ||||||||
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| City: | SUWANEE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300246038 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7704421911 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/13/2019 | ||||||||
| LastUpdateDate: | 09/15/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/15/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 9895 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.