Provider Demographics
NPI:1790966059
Name:ALAN M SANDERS MD
Entity Type:Organization
Organization Name:ALAN M SANDERS MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:A
Authorized Official - Last Name:MADDOX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-745-8790
Mailing Address - Street 1:401 PAT HARALSON DRIVE
Mailing Address - Street 2:UNIT 2
Mailing Address - City:BLAIRSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30512-3101
Mailing Address - Country:US
Mailing Address - Phone:706-781-1966
Mailing Address - Fax:
Practice Address - Street 1:401 PAT HARALSON DRIVE
Practice Address - Street 2:UNIT 2
Practice Address - City:BLAIRSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30512-3101
Practice Address - Country:US
Practice Address - Phone:706-781-1966
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-15
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP3685Medicare PIN