MEDICARE: SANDRA RENDER

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	171W00000X	Contractor

General Provider Information

NPI Number	:	1720385149
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDRA RENDER

Provider Business Mailing Address
First Line	:	1425 17TH ST
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31901-2029
Country	:	US
Telephone Number	:	706-507-0500
Fax Number	:	706-507-0566

Provider Business Practice Location Address
First Line	:	1425 17TH ST
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31901-2029
Country	:	US
Telephone Number	:	706-507-0500
Fax Number	:	706-507-0566

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

Provider Enumeration Date	:	02/21/2011
Last Update Date	:	06/28/2011

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Directions to “ SANDRA RENDER ” Practice Location

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