Provider Demographics
NPI:1639388432
Name:SANFORD, KEN E (MD)
Entity Type:Individual
Prefix:DR
First Name:KEN
Middle Name:E
Last Name:SANFORD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:258 WELDON RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30215-5500
Mailing Address - Country:US
Mailing Address - Phone:770-932-4543
Mailing Address - Fax:770-932-4712
Practice Address - Street 1:2989 W ROCK QUARRY RD
Practice Address - Street 2:
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30519-4118
Practice Address - Country:US
Practice Address - Phone:770-932-4543
Practice Address - Fax:770-932-4712
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA036449207LP3000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207LP3000XAllopathic & Osteopathic PhysiciansAnesthesiologyPediatric Anesthesiology
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine