Provider Demographics
NPI:1275507113
Name:CORT, SAMUEL FITZROY JR (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:FITZROY
Last Name:CORT
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:289 JONESBORO RD STE 339
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-3725
Mailing Address - Country:US
Mailing Address - Phone:770-656-6639
Mailing Address - Fax:770-783-2042
Practice Address - Street 1:289 JONESBORO RD STE 339
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-3725
Practice Address - Country:US
Practice Address - Phone:770-656-6639
Practice Address - Fax:770-783-2042
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2015-06-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME825922085R0202X, 2085N0904X, 2085N0700X, 2085P0229X, 2085R0204X, 2085U0001X, 2085B0100X
OH35.0768312085R0202X
SC266082085R0202X
GA0542622085R0202X
MI43010830982085R0202X
NC1204432085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear Radiology
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
No2085P0229XAllopathic & Osteopathic PhysiciansRadiologyPediatric Radiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA348649033DMedicaid
FL262466400Medicaid
FL262466400Medicaid
E5812YMedicare ID - Type Unspecified