Healthcare Provider Details

I. General information

NPI: 1053379495
Provider Name (Legal Business Name): WILLIAM HOLT SANDERS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

980 JOHNSON FERRY RD NE STE 490
ATLANTA GA
30342-1626
US

IV. Provider business mailing address

3340 PEACHTREE RD NE STE 600
ATLANTA GA
30326-1000
US

V. Phone/Fax

Practice location:
  • Phone: 404-257-0133
  • Fax: 404-207-1337
Mailing address:
  • Phone: 404-266-9876
  • Fax: 404-266-2669

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number037669
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: