Provider Demographics
NPI:1063478691
Name:SANDERS, ALAN M (MD)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:M
Last Name:SANDERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:401 PAT HARALSON DRIVE
Mailing Address - Street 2:UNIT 2
Mailing Address - City:BLAIRSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30512
Mailing Address - Country:US
Mailing Address - Phone:706-781-1966
Mailing Address - Fax:706-781-1968
Practice Address - Street 1:194 HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:BLAIRSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30512-3139
Practice Address - Country:US
Practice Address - Phone:706-781-1966
Practice Address - Fax:706-781-1968
Is Sole Proprietor?:No
Enumeration Date:2006-04-22
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA039223207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890635JMedicaid
GA00676024BMedicaid
GA39223OtherLICENSE
GA39223OtherLICENSE
GA00676024BMedicaid