Provider Demographics
NPI:1043479850
Name:PRESTON, SAMUEL L III (DO)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:L
Last Name:PRESTON
Suffix:III
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6900 GEORGIA AVE NW
Mailing Address - Street 2:WALTER REED AMC BLG. 6, 3RD FLOOR, ADULT BHC
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20307-0003
Mailing Address - Country:US
Mailing Address - Phone:202-782-6061
Mailing Address - Fax:
Practice Address - Street 1:500 JOEL LOOP
Practice Address - Street 2:
Practice Address - City:FT. CAMPBELL
Practice Address - State:KY
Practice Address - Zip Code:42223
Practice Address - Country:US
Practice Address - Phone:270-798-8042
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-06
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102201883207Q00000X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine