MEDICARE: MRS. JEWEL MARIE 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	246RP1900X	Phlebotomy Technician		GA

General Provider Information

NPI Number	:	1598624439
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JEWEL MARIE SANDERS

Provider Business Mailing Address
First Line	:	196 VIRGINIA AVE S UNIT 1118
Second Line	:
City	:	TIFTON
State	:	GA
Zip	:	31794-8073
Country	:	US
Telephone Number	:	229-999-7794
Fax Number	:

Provider Business Practice Location Address
First Line	:	196 VIRGINIA AVE S UNIT 1118
Second Line	:
City	:	TIFTON
State	:	GA
Zip	:	31794-8073
Country	:	US
Telephone Number	:	229-999-7794
Fax Number	:

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

Provider Enumeration Date	:	01/16/2026
Last Update Date	:	01/16/2026

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