Provider Demographics
NPI:1053863951
Name:SANDERS, DEON
Entity Type:Individual
Prefix:
First Name:DEON
Middle Name:
Last Name:SANDERS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3378 GREENBRIAR PKWY SW APT 9201
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30331-0620
Mailing Address - Country:US
Mailing Address - Phone:678-446-5445
Mailing Address - Fax:
Practice Address - Street 1:2915 CHILHOWEE DR
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30331-9443
Practice Address - Country:US
Practice Address - Phone:678-446-5445
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-27
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC012673343900000X, 101YM0800X, 101Y00000X, 101YA0400X
GAAPC005267101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)