Healthcare Provider Details

I. General information

NPI: 1609091289
Provider Name (Legal Business Name): HORACE A SAUNDERS P.A.-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 10/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1505 NORTHSIDE BLVD. SUITE 1500
CUMMING GA
30041
US

IV. Provider business mailing address

1505 NORTHSIDE BLVD. SUITE 1500
CUMMING GA
30041
US

V. Phone/Fax

Practice location:
  • Phone: 770-781-5077
  • Fax: 770-781-3915
Mailing address:
  • Phone: 770-781-5077
  • Fax: 770-781-3915

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number005032
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5032
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number005032
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code207NP0225X
TaxonomyPediatric Dermatology Physician
License Number005032
License Number StateGA
# 5
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number005032
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: