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NPI Code Detail

MEDICARE: KELSEY SANDER LMSW

MEDICARE: KELSEY SANDER LMSW
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
11041C0700XClinical Social WorkerMSW008592GA

General Provider Information

NPI Number : 1366908246
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELSEY SANDER LMSW
Provider Business Mailing Address
First Line : 2800 ARCHWAY LN
Second Line :
City : ATLANTA
State : GA
Zip : 30341-4840
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3305 BRECKINRIDGE BLVD STE 116
Second Line :
City : DULUTH
State : GA
Zip : 30096-4932
Country : US
Telephone Number : 770-495-9775
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/15/2019
Last Update Date : 09/11/2019

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Directions to “ KELSEY SANDER LMSW” Practice Location

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