1639361181 NPI number — STEPHEN G. SANDERS MD, LLC

Table of content: CODY MILLER MS, ATC (NPI 1326553579)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639361181 NPI number — STEPHEN G. SANDERS MD, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STEPHEN G. SANDERS MD, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1639361181
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/17/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2257 TAYLOR RD
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
MONTGOMERY
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36117-7790
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
334-270-9914
Provider Business Mailing Address Fax Number:
334-270-3195

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
42104 HIGHWAY 195
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HALEYVILLE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35565-7053
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-486-2968
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/17/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SANDERS
Authorized Official First Name:
STEPHEN
Authorized Official Middle Name:
GRADY
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
205-486-2968

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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