Provider Demographics
NPI:1760510432
Name:SANDERS, DAVENA
Entity Type:Individual
Prefix:
First Name:DAVENA
Middle Name:
Last Name:SANDERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6015 FAYETTEVILLE RD
Mailing Address - Street 2:SUITE 211
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-6254
Mailing Address - Country:US
Mailing Address - Phone:919-323-8081
Mailing Address - Fax:919-572-0004
Practice Address - Street 1:9556 TARA BLVD
Practice Address - Street 2:SUITE 400
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236-6037
Practice Address - Country:US
Practice Address - Phone:678-610-1933
Practice Address - Fax:678-610-1633
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA125129163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse