Provider Demographics
NPI:1073981999
Name:DPS HEALTH AND WELLNESS
Entity Type:Organization
Organization Name:DPS HEALTH AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMUELS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:912-662-6501
Mailing Address - Street 1:19 COACH LEE HILL BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30458-2119
Mailing Address - Country:US
Mailing Address - Phone:912-662-6501
Mailing Address - Fax:912-681-1012
Practice Address - Street 1:19 COACH LEE HILL BLVD
Practice Address - Street 2:
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30458-4700
Practice Address - Country:US
Practice Address - Phone:912-662-6501
Practice Address - Fax:912-681-1012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-09
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003169430AMedicaid