Provider Demographics
NPI:1205484961
Name:SANDERS, ANDREW KEITH
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:KEITH
Last Name:SANDERS
Suffix:
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 1:2369 TRAFALGAR DR
Mailing Address - Street 2:
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39531-2277
Mailing Address - Country:US
Mailing Address - Phone:334-714-7429
Mailing Address - Fax:
Practice Address - Street 1:305 PAUL W BRYANT DR E
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35401-2055
Practice Address - Country:US
Practice Address - Phone:205-345-0192
Practice Address - Fax:205-759-8794
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-27
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
AL1540363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant