As Sandtown is an unincorporated community with no official recognition, the definition of its borders varies. The borders of Sandtown according to the petition for annexation to Atlanta are: Campbellton Road to the north, Atlanta (Arlington Estates and Fairway Acres neighborhoods) to the east, a line roughly following Boreal Way and Erin Road on the south (west of Camp Creek Parkway, Union Road), and Riverside Drive on the west. An earlier 2006 source would have included areas north of Campbellton Road and south of Erin Road.
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Sandtown and Buzzard's Roost were the two largest Native villages in the area where Atlanta would develop. After the Trail of Tears and the government of Georgia divided the territory into counties, Sandtown ended up in Campbell County (which was absorbed into Fulton County in 1932 along with Milton County).
The road now known as Cascade was originally an Indian trail known as the Sandtown Road and ran from the village on the Chattahoochee River near Utoy Creek east through what became Five Points then to the vicinity of Decatur. This was the oldest settled area in current Fulton County. Atlanta's first doctor, Joshua Gilbert, lived along the Sandtown Road near the present-day Cascade Nature Preserve. The Union Army used his home as a hospital during the Battle of Utoy Creek.
During the American Civil War there were two roads to Sandtown (the current Cascade and Campbelltown roads), which were prominent locations of Union Army operations during the Siege of Atlanta. The Battle of Utoy Creek was fought along the Sandtown (Cascade) Road in Cascade Heights from 1–7 August 1864. Major General William T. Sherman's headquarters was along the southern Sandtown (Campbellton) Road on 26 August 1864.
In 2006 Sandtown appied for annexation to the city of Atlanta. Atlanta put Sandtown's application on hold. In 2007 a vote in unincorporated southern Fulton County, including Sandtown, on whether to form a new city of South Fulton, Georgia, resulted against such a formation.
The neighborhood is served by State Route 6 (SR 6; Camp Creek Parkway) and SR 154/SR 166 (Campbellton Road SW). Boat Rock Road intersects SR 154/SR 166 on the northeastern corner of the commonly accepted boundary.
The Sandtown Community Association, previously known as the Sandtown Homeowners Association, is a registered nearly 20-year-old community advocacy organization. It is a voluntary community-based group that addresses issues regarding zonings, residential/commercial development, land use and education.