| Jennifer M Sanderson, DO | |
| 1805 Vernon Rd Ste C, Lagrange, GA 30240-4041 | |
| (706) 812-9902 | |
| (706) 812-0802 | 
| Full Name | Jennifer M Sanderson | 
|---|---|
| Gender | Female | 
| Speciality | Anesthesiology | 
| Location | 1805 Vernon Rd Ste C, Lagrange, Georgia | 
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. | 
| Identifier | Type | State | Issuer | 
|---|---|---|---|
| 1871593582 | NPI | - | NPPES | 
| 494310324A | Medicaid | GA | 
| Taxonomy | Type | License (State) | Status | 
|---|---|---|---|
| 207L00000X | Anesthesiology | 053028 (Georgia) | Primary | 
| Entity Name | Emory Specialty Associates, Llc | 
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice | 
| Entity Identifiers | NPI Number: 1407864168 PECOS PAC ID: 3476559782 Enrollment ID: O20061010000447 | 
| Mailing Address | Practice Location Address | 
|---|---|
| Jennifer M Sanderson, DO 1805 Vernon Rd Ste C, Lagrange, GA 30240-4041 Ph: (706) 812-9902 | Jennifer M Sanderson, DO 1805 Vernon Rd Ste C, Lagrange, GA 30240-4041 Ph: (706) 812-9902 | 
| John William Carl Carter Mallett, MD Anesthesiology Medicare: Medicare Enrolled Practice Location: 1075 Lafayette Pkwy Ste 100, Lagrange, GA 30241 Phone: 706-443-5273 Fax: 706-443-5275 | |
| Jung H Ahn, MD Anesthesiology Medicare: Not Enrolled in Medicare Practice Location: 1514 Vernon Rd, Lagrange, GA 30240 Phone: 706-882-1411 | |
| Dr. Deborah A Simmons, MD Anesthesiology Medicare: Medicare Enrolled Practice Location: 1805 Vernon Rd, Suite C, Lagrange, GA 30240 Phone: 706-812-9902 Fax: 706-812-0802 | |
| Davin Mitchell, M.D. Anesthesiology Medicare: Accepting Medicare Assignments Practice Location: 1075 Lafayette Pkwy, Ste 100, Lagrange, GA 30241 Phone: 706-593-3256 Fax: 706-443-5275 |