Provider Demographics
NPI:1164524765
Name:SANDERS, JOHN CLINTON (MAT, MS, LAT, ATC)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:CLINTON
Last Name:SANDERS
Suffix:
Gender:M
Credentials:MAT, MS, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4120 HELENA BAY CT
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:TN
Mailing Address - Zip Code:37076-3105
Mailing Address - Country:US
Mailing Address - Phone:615-268-9868
Mailing Address - Fax:
Practice Address - Street 1:300 DANYACREST DR
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37214-2383
Practice Address - Country:US
Practice Address - Phone:615-268-9868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2015-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN00000006592255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer