Provider Demographics
NPI:1124219076
Name:SANDERS, DAVID D (CRNA)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:D
Last Name:SANDERS
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1509 GILSTRAP LN NW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30318-2775
Mailing Address - Country:US
Mailing Address - Phone:404-210-8886
Mailing Address - Fax:770-696-1698
Practice Address - Street 1:1509 GILSTRAP LN NW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30318-2775
Practice Address - Country:US
Practice Address - Phone:404-210-8886
Practice Address - Fax:678-620-2242
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-06
Last Update Date:2014-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN078001367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAR12297Medicare UPIN
GA43ZCBJA26Medicare PIN