Provider Demographics
NPI:1164441150
Name:SANDERS, KATHARINE WATSON (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHARINE
Middle Name:WATSON
Last Name:SANDERS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 608
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30673-0608
Mailing Address - Country:US
Mailing Address - Phone:706-678-3793
Mailing Address - Fax:706-678-2732
Practice Address - Street 1:124 GORDON ST
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:GA
Practice Address - Zip Code:30673-1602
Practice Address - Country:US
Practice Address - Phone:706-678-3793
Practice Address - Fax:706-678-2732
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2017-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA020695208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202I011354OtherMEDICARE PTAN
1164441150Medicare UPIN