Provider Demographics
NPI:1922680792
Name:SANDERS, LIBBY NICOLE (CNM)
Entity Type:Individual
Prefix:
First Name:LIBBY
Middle Name:NICOLE
Last Name:SANDERS
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1475 S GORDON ST SW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30310-2331
Mailing Address - Country:US
Mailing Address - Phone:615-944-3934
Mailing Address - Fax:
Practice Address - Street 1:315 BOULEVARD NE STE 224
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30312-1220
Practice Address - Country:US
Practice Address - Phone:404-448-2775
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-22
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN259530367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife