Healthcare Provider Details

I. General information

NPI: 1467429126
Provider Name (Legal Business Name): BUDDY D. SANDERS M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BUDDY D. SANDERS CAC, LCC

II. Dates (important events)

Enumeration Date: 03/02/2006
Last Update Date: 05/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 DAVIS ROAD SUITE 1- B
MARTINEZ GA
30907-0200
US

IV. Provider business mailing address

P. O. BOX 212401
MARTINEZ GA
30917-2401
US

V. Phone/Fax

Practice location:
  • Phone: 706-869-0071
  • Fax: 706-869-0063
Mailing address:
  • Phone: 706-869-0071
  • Fax: 706-869-0063

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number06040351
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateGA
# 5
Primary TaxonomyN
Taxonomy Code171W00000X
TaxonomyContractor
License NumberTG-BFTS-9712
License Number StateGA
# 6
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberPD--BFTS-9965
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: