MEDICARE: JENNIFER SANDERS PA-C

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	363A00000X	Physician Assistant	003047	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

General Provider Information

NPI Number	:	1225031867
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER SANDERS PA-C

Provider Business Mailing Address
First Line	:	250 MARTIN LUTHER KING JR BLVD
Second Line	:
City	:	MACON
State	:	GA
Zip	:	31201-3490
Country	:	US
Telephone Number	:	478-301-2362
Fax Number	:	478-301-2272

Provider Business Practice Location Address
First Line	:	101 HARTFORD RD W STE 1
Second Line	:
City	:	FORT GAINES
State	:	GA
Zip	:	39851-4331
Country	:	US
Telephone Number	:	229-210-2100
Fax Number	:	478-301-5812

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

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	11/23/2020

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