Healthcare Provider Details

I. General information

NPI: 1720919848
Provider Name (Legal Business Name): THE VILLAGE COLLABORATIVE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3961 COLUMBIA RD UNIT B
MARTINEZ GA
30907-2219
US

IV. Provider business mailing address

3961 COLUMBIA RD UNIT B
MARTINEZ GA
30907-2219
US

V. Phone/Fax

Practice location:
  • Phone: 706-432-1141
  • Fax:
Mailing address:
  • Phone: 706-432-1141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. SANDRA DUNN ANDERSON
Title or Position: MEMBER
Credential: DC
Phone: 706-432-1141