Provider Demographics
NPI:1144706540
Name:SANDERS, MARQUITA CHRISHAY (MED)
Entity type:Individual
Prefix:MISS
First Name:MARQUITA
Middle Name:CHRISHAY
Last Name:SANDERS
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:881 BOYD RD
Mailing Address - Street 2:
Mailing Address - City:SHORTER
Mailing Address - State:AL
Mailing Address - Zip Code:36075-4027
Mailing Address - Country:US
Mailing Address - Phone:334-296-1645
Mailing Address - Fax:
Practice Address - Street 1:6200 BRADLEY PARK DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-3078
Practice Address - Country:US
Practice Address - Phone:706-221-2024
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-18
Last Update Date:2018-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health