Provider Demographics
NPI:1235239914
Name:SAPP, SAMUEL (CPHT)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:
Last Name:SAPP
Suffix:
Gender:M
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1362 BEAVER OAKS DR
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31220-5101
Mailing Address - Country:US
Mailing Address - Phone:478-477-7732
Mailing Address - Fax:
Practice Address - Street 1:4839 BLOOMFIELD RD
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31206-4307
Practice Address - Country:US
Practice Address - Phone:478-781-1213
Practice Address - Fax:478-788-9078
Is Sole Proprietor?:No
Enumeration Date:2006-09-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician