Healthcare Provider Details

I. General information

NPI: 1588577514
Provider Name (Legal Business Name): GEORGIA CHRISTIAN SANDERS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1445 WOODMONT LN NW STE 4962
ATLANTA GA
30318-2866
US

IV. Provider business mailing address

128 BIRCHWOOD DR
LEESBURG GA
31763-5114
US

V. Phone/Fax

Practice location:
  • Phone: 678-921-9969
  • Fax:
Mailing address:
  • Phone: 850-252-5031
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW010681
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: