Provider Demographics
NPI:1295706356
Name:SANDERS, PAMELA J (MD)
Entity type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:J
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 1:1611 S JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38506-5566
Mailing Address - Country:US
Mailing Address - Phone:931-644-4026
Mailing Address - Fax:931-933-7765
Practice Address - Street 1:1611 S JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38506-5566
Practice Address - Country:US
Practice Address - Phone:931-644-0262
Practice Address - Fax:931-933-7765
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD40043207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3333752Medicaid
4113655OtherBCBST
7871682OtherAETNA
7871682OtherAETNA
I40892Medicare UPIN
3333752Medicare PIN
TN4113655OtherBLUECARE-PARROTTSVILLE
TN4113659OtherBCBST
TN4113657OtherBCBST