MEDICARE: MR. DAVID D SANDERS CRNA

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
1	367500000X	Certified Registered Nurse Anesthetist	RN078001	GA

General Provider Information

NPI Number	:	1124219076
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DAVID D SANDERS CRNA

Provider Business Mailing Address
First Line	:	1509 GILSTRAP LN NW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30318-2775
Country	:	US
Telephone Number	:	404-210-8886
Fax Number	:	770-696-1698

Provider Business Practice Location Address
First Line	:	1509 GILSTRAP LN NW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30318-2775
Country	:	US
Telephone Number	:	404-210-8886
Fax Number	:	678-620-2242

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/06/2007
Last Update Date	:	07/10/2014

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