Provider Demographics
NPI:1699035378
Name:SANDERS, CARSON LEWIS (MD)
Entity Type:Individual
Prefix:
First Name:CARSON
Middle Name:LEWIS
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 935722
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:31193-5722
Mailing Address - Country:US
Mailing Address - Phone:843-792-6200
Mailing Address - Fax:
Practice Address - Street 1:1580 FREEDOM BLVD STE 100
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29505-6074
Practice Address - Country:US
Practice Address - Phone:843-413-6835
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-29
Last Update Date:2022-04-28
Deactivation Date:2019-06-11
Deactivation Code:
Reactivation Date:2019-06-14
Provider Licenses
StateLicense IDTaxonomies
NC2022-00681207X00000X
SC346771207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery