Provider Demographics
NPI:1386103539
Name:SANDERS, MAR'QUENDA (MD)
Entity type:Individual
Prefix:
First Name:MAR'QUENDA
Middle Name:
Last Name:SANDERS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1918 NORTHLAKE PKWY # 201-202
Mailing Address - Street 2:
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-7070
Mailing Address - Country:US
Mailing Address - Phone:404-366-3636
Mailing Address - Fax:770-947-7904
Practice Address - Street 1:1918 NORTHLAKE PKWY STE 201&202
Practice Address - Street 2:
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-7070
Practice Address - Country:US
Practice Address - Phone:770-809-3332
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-18
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA93288208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics