Provider Demographics
NPI:1053505560
Name:NIGHTINGALE, SAMUEL (SURGICAL FIRST ASST)
Entity Type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:
Last Name:NIGHTINGALE
Suffix:
Gender:M
Credentials:SURGICAL FIRST ASST
Other - Prefix:
Other - First Name:SAMUEL
Other - Middle Name:
Other - Last Name:NIGHTINGALE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CERTIFIED SURGICAL A
Mailing Address - Street 1:2221 PEACHTREE RD NE
Mailing Address - Street 2:SUITE D-312
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-1148
Mailing Address - Country:US
Mailing Address - Phone:404-468-7781
Mailing Address - Fax:770-785-9882
Practice Address - Street 1:2221 PEACHTREE RD NE
Practice Address - Street 2:SUITE D-312
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-1148
Practice Address - Country:US
Practice Address - Phone:404-468-7781
Practice Address - Fax:770-785-9882
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-29
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Y00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Health Information