Provider Demographics
NPI:1740341429
Name:SANDERS, JOHN DAVID
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:DAVID
Last Name:SANDERS
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:JOHN
Other - Middle Name:DAVID
Other - Last Name:SANDERS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA-C
Mailing Address - Street 1:2970 ARROWWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:HEPHZIBAH
Mailing Address - State:GA
Mailing Address - Zip Code:30815-7078
Mailing Address - Country:US
Mailing Address - Phone:706-796-1137
Mailing Address - Fax:
Practice Address - Street 1:300 W HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:FORT GORDON
Practice Address - State:GA
Practice Address - Zip Code:30905-5741
Practice Address - Country:US
Practice Address - Phone:706-787-4697
Practice Address - Fax:706-787-4697
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant