Healthcare Provider Details

I. General information

NPI: 1124219076
Provider Name (Legal Business Name): DAVID D SANDERS CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2007
Last Update Date: 07/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1509 GILSTRAP LN NW
ATLANTA GA
30318-2775
US

IV. Provider business mailing address

1509 GILSTRAP LN NW
ATLANTA GA
30318-2775
US

V. Phone/Fax

Practice location:
  • Phone: 404-210-8886
  • Fax: 678-620-2242
Mailing address:
  • Phone: 404-210-8886
  • Fax: 770-696-1698

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN078001
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: