Provider Demographics
NPI:1154155406
Name:SANDERS, WILLIAM BENNETT IV
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:BENNETT
Last Name:SANDERS
Suffix:IV
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6559 WILDLIFE CIR
Mailing Address - Street 2:
Mailing Address - City:PINEY FLATS
Mailing Address - State:TN
Mailing Address - Zip Code:37686-2947
Mailing Address - Country:US
Mailing Address - Phone:276-623-6226
Mailing Address - Fax:
Practice Address - Street 1:6559 WILDLIFE CIR
Practice Address - Street 2:
Practice Address - City:PINEY FLATS
Practice Address - State:TN
Practice Address - Zip Code:37686-2947
Practice Address - Country:US
Practice Address - Phone:276-623-6226
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-29
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN245815163WE0003X
TN37294363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WE0003XNursing Service ProvidersRegistered NurseEmergency