Healthcare Provider Details

I. General information

NPI: 1205484961
Provider Name (Legal Business Name): ANDREW KEITH SANDERS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2019
Last Update Date: 06/09/2025
Certification Date: 06/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 PAUL W BRYANT DR E
TUSCALOOSA AL
35401-2055
US

IV. Provider business mailing address

2369 TRAFALGAR DR
BILOXI MS
39531-2277
US

V. Phone/Fax

Practice location:
  • Phone: 205-345-0192
  • Fax: 205-759-8794
Mailing address:
  • Phone: 334-714-7429
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number1540
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: