Provider Demographics
NPI:1700328143
Name:ZANDERS, ROOSVELT JR
Entity Type:Individual
Prefix:
First Name:ROOSVELT
Middle Name:
Last Name:ZANDERS
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 DAVIS DR
Mailing Address - Street 2:
Mailing Address - City:AMERICUS
Mailing Address - State:GA
Mailing Address - Zip Code:31719-2406
Mailing Address - Country:US
Mailing Address - Phone:229-410-9794
Mailing Address - Fax:
Practice Address - Street 1:1515 DAVIS DR
Practice Address - Street 2:
Practice Address - City:AMERICUS
Practice Address - State:GA
Practice Address - Zip Code:31719-2406
Practice Address - Country:US
Practice Address - Phone:229-410-9794
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-16
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor