Healthcare Provider Details

I. General information

NPI: 1083242127
Provider Name (Legal Business Name): LAURA D SANDERS DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2020
Last Update Date: 10/24/2024
Certification Date: 10/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 22ND AVE N
NASHVILLE TN
37203-1852
US

IV. Provider business mailing address

2000 CHURCH STREET BOX 102
NASHVILLE TN
37236-0001
US

V. Phone/Fax

Practice location:
  • Phone: 629-255-2497
  • Fax: 629-255-4261
Mailing address:
  • Phone: 615-284-4672
  • Fax: 615-284-5752

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number5024
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: