Healthcare Provider Details

I. General information

NPI: 1639361181
Provider Name (Legal Business Name): STEPHEN G. SANDERS MD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2007
Last Update Date: 08/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42104 HIGHWAY 195
HALEYVILLE AL
35565-7053
US

IV. Provider business mailing address

2257 TAYLOR RD SUITE 200
MONTGOMERY AL
36117-7790
US

V. Phone/Fax

Practice location:
  • Phone: 205-486-2968
  • Fax:
Mailing address:
  • Phone: 334-270-9914
  • Fax: 334-270-3195

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. STEPHEN GRADY SANDERS
Title or Position: OWNER
Credential: M.D.
Phone: 205-486-2968