Healthcare Provider Details

I. General information

NPI: 1033563317
Provider Name (Legal Business Name): LUCY JOHNSTON SANDERS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2016
Last Update Date: 08/20/2020
Certification Date: 08/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

806 SAINT VINCENTS DR STE 500
BIRMINGHAM AL
35205-1616
US

IV. Provider business mailing address

806 SAINT VINCENTS DR STE 500
BIRMINGHAM AL
35205-1616
US

V. Phone/Fax

Practice location:
  • Phone: 205-930-1800
  • Fax:
Mailing address:
  • Phone: 205-930-1800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number36550
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: