Provider Demographics
NPI:1750110896
Name:SANDERS, LEAH M (PA (ASCP))
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:M
Last Name:SANDERS
Suffix:
Gender:F
Credentials:PA (ASCP)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1344 BALSAM DR
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-2905
Mailing Address - Country:US
Mailing Address - Phone:404-512-9410
Mailing Address - Fax:
Practice Address - Street 1:1000 MEDICAL CENTER BLVD
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-7694
Practice Address - Country:US
Practice Address - Phone:678-312-4526
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-29
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA3205246R00000X
246R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246R00000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
3205OtherASCP
GA3205OtherASCP