Provider Demographics
NPI:1225403389
Name:PARHAM, SAMUEL
Entity Type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:
Last Name:PARHAM
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:SAMUEL
Other - Middle Name:W
Other - Last Name:PARHAM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MED
Mailing Address - Street 1:5603 SE COUNTY ROAD 346
Mailing Address - Street 2:
Mailing Address - City:MICANOPY
Mailing Address - State:FL
Mailing Address - Zip Code:32667-3937
Mailing Address - Country:US
Mailing Address - Phone:352-359-2360
Mailing Address - Fax:
Practice Address - Street 1:7731 W NEWBERRY RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606-9246
Practice Address - Country:US
Practice Address - Phone:352-359-2360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-01
Last Update Date:2015-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health