MEDICARE: JENNIFER SANDERSON-SMITH MD

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	207Q00000X	Family Medicine Physician	85830	GA
2	390200000X	Student in an Organized Health Care Education/Training Program
3	207Q00000X	Family Medicine Physician	25MA11320000	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1497282644
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER SANDERSON-SMITH MD

Provider Business Mailing Address
First Line	:	1301 HODGES DR
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32308-4614
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7313 VENTNOR AVE
Second Line	:
City	:	VENTNOR CITY
State	:	NJ
Zip	:	08406-1958
Country	:	US
Telephone Number	:	609-441-2199
Fax Number	:

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

Provider Enumeration Date	:	05/18/2017
Last Update Date	:	07/17/2024

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