Provider Demographics
NPI:1689763633
Name:SANDERS, FLOYD STUART (MD)
Entity Type:Individual
Prefix:
First Name:FLOYD
Middle Name:STUART
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:PO BOX 909
Mailing Address - Street 2:
Mailing Address - City:CLARKESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30523-0016
Mailing Address - Country:US
Mailing Address - Phone:706-754-5191
Mailing Address - Fax:706-754-1725
Practice Address - Street 1:207 ADAMS DR
Practice Address - Street 2:
Practice Address - City:DEMOREST
Practice Address - State:GA
Practice Address - Zip Code:30535-4501
Practice Address - Country:US
Practice Address - Phone:706-754-5191
Practice Address - Fax:706-754-1725
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA26375207R00000X, 207RS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RS0010XAllopathic & Osteopathic PhysiciansInternal MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00300605DMedicaid
GA11BDHSROtherMEDICARE PTAN
GA336039OtherWELLCARE
GA110104731OtherRAILROAD MEDICARE
GA110104731OtherRAILROAD MEDICARE