Healthcare Provider Details

I. General information

NPI: 1902021215
Provider Name (Legal Business Name): KAREN SAUNDERS BLAIR CANP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 JO DOTSON CIR
CLAYTON GA
30525-5007
US

IV. Provider business mailing address

PO BOX 1
TIGER GA
30576-0001
US

V. Phone/Fax

Practice location:
  • Phone: 706-212-0028
  • Fax: 706-212-0296
Mailing address:
  • Phone: 706-782-3877
  • Fax: 706-212-0296

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberRN031448
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: