1558492157 NPI number — JOE ALVIN SANDERS C.R.N.A.

Table of content: MS. SANDRA M SUMMERS PNP (NPI 1427076900)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558492157 NPI number — JOE ALVIN SANDERS C.R.N.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SANDERS
Provider First Name:
JOE
Provider Middle Name:
ALVIN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
C.R.N.A.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1558492157
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

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

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
601 BLUEBIRD BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT VALLEY
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31030-5082
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
478-825-8691
Provider Business Practice Location Address Fax Number:
478-825-4458
Provider Enumeration Date:
03/08/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 367500000X , with the licence number:  RN113320 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000784979D , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2026 www.npivalidator.com