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General NPI Number Information
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NPI Number | 1942963566
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Entity Type | Individual
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Provider Name | ALVIN SANDERSON III NP
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Gender | Male
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Dates
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Enumeration Date | 10/20/2021
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Last Update Date | 10/20/2021
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Provider Practice Location Address
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Address Line | 1700 TREE LN STE 190
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City | SNELLVILLE
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State | GA
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Zip | 30078-6766
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Country | US
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Telephone | 205-683-5571
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Fax |
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Provider Business Mailing Address
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Address Line | 19 COLLEGE ST UNIT 263
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City | AUBURN
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State | GA
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Zip | 30011-4303
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Country | US
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Telephone | 770-601-3108
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | RN260312
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License Number State | GA
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