MEDICARE: KIMBERLY 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
1	171W00000X	Contractor

General Provider Information

NPI Number	:	1194250647
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY SANDERS

Provider Business Mailing Address
First Line	:	803 MAGNOLIA WAY NW APT 1413
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30314-5001
Country	:	US
Telephone Number	:	678-505-0262
Fax Number	:

Provider Business Practice Location Address
First Line	:	803 MAGNOLIA WAY NW APT 1413
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30314-5001
Country	:	US
Telephone Number	:	678-505-0262
Fax Number	:

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

Provider Enumeration Date	:	04/21/2017
Last Update Date	:	04/21/2017

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Directions to “ KIMBERLY SANDERS ” Practice Location

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