MEDICARE: JOE ALVIN SANDERS C.R.N.A.

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	RN113320	GA

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	:	1558492157
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOE ALVIN SANDERS C.R.N.A.

Provider Business Mailing Address
First Line	:	4581 THIRD DISTRICT RD
Second Line	:
City	:	UNADILLA
State	:	GA
Zip	:	31091-4139
Country	:	US
Telephone Number	:	229-645-3495
Fax Number	:

Provider Business Practice Location Address
First Line	:	601 BLUEBIRD BLVD
Second Line	:
City	:	FORT VALLEY
State	:	GA
Zip	:	31030-5082
Country	:	US
Telephone Number	:	478-825-8691
Fax Number	:	478-825-4458

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

Provider Enumeration Date	:	03/08/2007
Last Update Date	:	07/08/2007

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