Provider Demographics
NPI:1861843435
Name:MANDERS, SHEENA POWELL (PA-C)
Entity type:Individual
Prefix:MRS
First Name:SHEENA
Middle Name:POWELL
Last Name:MANDERS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1240 HIGHWAY 54 W STE 710
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-4565
Mailing Address - Country:US
Mailing Address - Phone:770-991-2800
Mailing Address - Fax:
Practice Address - Street 1:1240 HIGHWAY 54 W STE 710
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-4565
Practice Address - Country:US
Practice Address - Phone:770-991-2800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-24
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA7986363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant