Provider Demographics
NPI:1033516554
Name:MASSIE, SAMUEL POWELL (MD)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:POWELL
Last Name:MASSIE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 PERKINS MILL RD
Mailing Address - Street 2:
Mailing Address - City:LOWESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22967-6045
Mailing Address - Country:US
Mailing Address - Phone:434-277-5280
Mailing Address - Fax:
Practice Address - Street 1:111 PERKINS MILL RD
Practice Address - Street 2:
Practice Address - City:LOWESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22967-6045
Practice Address - Country:US
Practice Address - Phone:434-277-5280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-26
Last Update Date:2014-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101016936207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine