Provider Demographics
NPI:1033639612
Name:SAMS, TARALYN RAE (RN)
Entity Type:Individual
Prefix:
First Name:TARALYN
Middle Name:RAE
Last Name:SAMS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1435 N EXPRESSWAY STE 301
Mailing Address - Street 2:
Mailing Address - City:GRIFFIN
Mailing Address - State:GA
Mailing Address - Zip Code:30223-9014
Mailing Address - Country:US
Mailing Address - Phone:770-358-5252
Mailing Address - Fax:770-229-3223
Practice Address - Street 1:109 NORTH 10TH STREET
Practice Address - Street 2:
Practice Address - City:GRIFFIN
Practice Address - State:GA
Practice Address - Zip Code:30223
Practice Address - Country:US
Practice Address - Phone:770-358-5252
Practice Address - Fax:770-229-3223
Is Sole Proprietor?:No
Enumeration Date:2017-06-23
Last Update Date:2017-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN210324163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse