Healthcare Provider Details

I. General information

NPI: 1386103539
Provider Name (Legal Business Name): MAR'QUENDA SANDERS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2019
Last Update Date: 05/08/2025
Certification Date: 05/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5440 HILLANDALE DR
LITHONIA GA
30058-4865
US

IV. Provider business mailing address

1918 NORTHLAKE PKWY # 201-202
TUCKER GA
30084-7070
US

V. Phone/Fax

Practice location:
  • Phone: 770-809-3332
  • Fax:
Mailing address:
  • Phone: 404-366-3636
  • Fax: 770-947-7904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number93288
License Number StateGA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: