Individual
SHANEKA SANDERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
8460 COURTHOUSE SQ E FL 4, DOUGLASVILLE, GA 30134-4555
(470) 505-7848
Mailing address
PO BOX 723, DOUGLASVILLE, GA 30133-0723
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CN0028730203
CN0028730203
GA
Enumeration date
09/02/2021
Last updated
09/02/2021
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