Provider Demographics
NPI:1942963566
Name:SANDERSON, ALVIN III (NP)
Entity Type:Individual
Prefix:
First Name:ALVIN
Middle Name:
Last Name:SANDERSON
Suffix:III
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 COLLEGE ST UNIT 263
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30011-4303
Mailing Address - Country:US
Mailing Address - Phone:770-601-3108
Mailing Address - Fax:
Practice Address - Street 1:1700 TREE LN STE 190
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-6766
Practice Address - Country:US
Practice Address - Phone:205-683-5571
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-20
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN260312363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health