Provider Demographics
NPI:1053443275
Name:SAMS, MARY (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:
Last Name:SAMS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:875 JOHNSON FY RD NE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1418
Mailing Address - Country:US
Mailing Address - Phone:404-497-1020
Mailing Address - Fax:404-252-4030
Practice Address - Street 1:875 JOHNSON FY RD NE
Practice Address - Street 2:SUITE 200
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1418
Practice Address - Country:US
Practice Address - Phone:404-497-1020
Practice Address - Fax:404-252-4030
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA040536207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000944182CMedicaid
GA000944182EMedicaid
GA000944182BMedicaid
GA000944182DMedicaid
GAF88262Medicare UPIN
GA000944182BMedicaid
GA000944182EMedicaid