Healthcare Provider Details

I. General information

NPI: 1447579495
Provider Name (Legal Business Name): ALBERT H SANDERS NP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2010
Last Update Date: 02/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2274 HIGHWAY 43 S
PICAYUNE MS
39466-8141
US

IV. Provider business mailing address

2274 HIGHWAY 43 S
PICAYUNE MS
39466-8141
US

V. Phone/Fax

Practice location:
  • Phone: 601-798-3989
  • Fax: 601-798-3964
Mailing address:
  • Phone: 601-798-3989
  • Fax: 601-798-3964

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR877250
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: