Provider Demographics
NPI:1376098954
Name:SAMPSON, TONY ANTHONY JR
Entity Type:Individual
Prefix:MR
First Name:TONY
Middle Name:ANTHONY
Last Name:SAMPSON
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3236 MERCER UNIVERSITY DR APT 212
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30341-5661
Mailing Address - Country:US
Mailing Address - Phone:229-834-8772
Mailing Address - Fax:
Practice Address - Street 1:2444 DALLAS HWY SW
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30064-2529
Practice Address - Country:US
Practice Address - Phone:770-218-2763
Practice Address - Fax:770-218-3819
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-24
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH029374183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist