Provider Demographics
NPI:1215979257
Name:SANDERS, HARVEY J JR (MD)
Entity type:Individual
Prefix:DR
First Name:HARVEY
Middle Name:J
Last Name:SANDERS
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 JONES AVE
Mailing Address - Street 2:
Mailing Address - City:WAYNESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30830-1510
Mailing Address - Country:US
Mailing Address - Phone:706-554-5147
Mailing Address - Fax:706-554-6111
Practice Address - Street 1:305 JONES AVE
Practice Address - Street 2:
Practice Address - City:WAYNESBORO
Practice Address - State:GA
Practice Address - Zip Code:30830-1510
Practice Address - Country:US
Practice Address - Phone:706-554-5147
Practice Address - Fax:706-554-6111
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA16975207R00000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAD41042Medicare UPIN
GA$$$$$$$$$AMedicare PIN