Individual
JENNIFER M SANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
1805 VERNON RD STE C, LAGRANGE, GA 30240-4041
(706) 812-9902
(706) 812-0802
Mailing address
1805 VERNON RD STE C, LAGRANGE, GA 30240-4041
(706) 812-9902
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
053028
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
494310324A
—
GA
Enumeration date
07/22/2005
Last updated
06/22/2010
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