Provider Demographics
NPI:1164492179
Name:SANDERS, HERBERT F (MD)
Entity Type:Individual
Prefix:
First Name:HERBERT
Middle Name:F
Last Name:SANDERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6602 WATERS AVE
Mailing Address - Street 2:BUILDING C
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-2716
Mailing Address - Country:US
Mailing Address - Phone:912-354-7676
Mailing Address - Fax:
Practice Address - Street 1:6602 WATERS AVE
Practice Address - Street 2:BUILDING C
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-2716
Practice Address - Country:US
Practice Address - Phone:912-354-7676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2010-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA177302084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000132426FMedicaid
GA000132426FMedicaid
GAD41038Medicare UPIN