Provider Demographics
NPI:1588613830
Name:SANDERS, JAMES LARRY (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:LARRY
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 1:1108 PROFESSIONAL BLVD
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30720-2588
Mailing Address - Country:US
Mailing Address - Phone:706-226-6542
Mailing Address - Fax:706-226-1273
Practice Address - Street 1:1108 PROFESSIONAL BLVD
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720-2588
Practice Address - Country:US
Practice Address - Phone:706-226-6542
Practice Address - Fax:706-226-1273
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-06
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA013237207L00000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00018719AMedicaid
GAD42185Medicare UPIN
GA00018719AMedicaid