MEDICARE: ALAN M SANDERS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	039223	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	39223	OTHER	GA	LICENSE

General Provider Information

NPI Number	:	1063478691
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALAN M SANDERS MD

Provider Business Mailing Address
First Line	:	401 PAT HARALSON DRIVE
Second Line	:	UNIT 2
City	:	BLAIRSVILLE
State	:	GA
Zip	:	30512
Country	:	US
Telephone Number	:	706-781-1966
Fax Number	:	706-781-1968

Provider Business Practice Location Address
First Line	:	194 HOSPITAL RD
Second Line	:
City	:	BLAIRSVILLE
State	:	GA
Zip	:	30512-3139
Country	:	US
Telephone Number	:	706-781-1966
Fax Number	:	706-781-1968

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/22/2006
Last Update Date	:	11/02/2022

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