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NPI Code Detail

MEDICARE: DEON SANDERS

MEDICARE: DEON SANDERS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1343900000XNon-emergency Medical Transport (VAN)LPC012673GA
2101YP2500XProfessional CounselorAPC005267GA
3101YM0800XMental Health CounselorLPC012673GA
4101Y00000XCounselorLPC012673GA
5101YA0400XAddiction (Substance Use Disorder) CounselorLPC012673GA

General Provider Information

NPI Number : 1053863951
Entity Type Code : Individual
Provider Name (Legal Business Name) : DEON SANDERS
Provider Business Mailing Address
First Line : 3378 GREENBRIAR PKWY SW APT 9201
Second Line :
City : ATLANTA
State : GA
Zip : 30331-0620
Country : US
Telephone Number : 678-446-5445
Fax Number :
Provider Business Practice Location Address
First Line : 2915 CHILHOWEE DR
Second Line :
City : ATLANTA
State : GA
Zip : 30331-9443
Country : US
Telephone Number : 678-446-5445
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/27/2016
Last Update Date : 01/25/2022

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Directions to “ DEON SANDERS ” Practice Location

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