Provider Demographics
NPI:1992366231
Name:SANDERS, TYLER JAMESON (NP)
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:JAMESON
Last Name:SANDERS
Suffix:
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 1:3611 ACORN CT NE
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30012-1904
Mailing Address - Country:US
Mailing Address - Phone:404-372-8744
Mailing Address - Fax:
Practice Address - Street 1:215 AZALEA CT
Practice Address - Street 2:
Practice Address - City:SOCIAL CIRCLE
Practice Address - State:GA
Practice Address - Zip Code:30025-5037
Practice Address - Country:US
Practice Address - Phone:770-464-5858
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-26
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN248374363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily