Provider Demographics
NPI:1801007414
Name:SANDERS, TAWIAH SHUKURA (DPT)
Entity Type:Individual
Prefix:DR
First Name:TAWIAH
Middle Name:SHUKURA
Last Name:SANDERS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6161 KENTON OAKS CT
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30058-3943
Mailing Address - Country:US
Mailing Address - Phone:404-514-8351
Mailing Address - Fax:678-323-7177
Practice Address - Street 1:6635 LAKE DR
Practice Address - Street 2:
Practice Address - City:MORROW
Practice Address - State:GA
Practice Address - Zip Code:30260-2354
Practice Address - Country:US
Practice Address - Phone:678-422-4300
Practice Address - Fax:678-422-4299
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT007889225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist