Provider Demographics
NPI:1376555300
Name:SAMUEL E. PALMER, MD, PC
Entity Type:Organization
Organization Name:SAMUEL E. PALMER, MD, PC
Other - Org Name:HOUSTON FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:PALMER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:478-988-1282
Mailing Address - Street 1:106 MORAN DRIVE
Mailing Address - Street 2:
Mailing Address - City:BONAIRE
Mailing Address - State:GA
Mailing Address - Zip Code:31005-2948
Mailing Address - Country:US
Mailing Address - Phone:478-988-1282
Mailing Address - Fax:478-988-3120
Practice Address - Street 1:106 MORAN DRIVE
Practice Address - Street 2:
Practice Address - City:BONAIRE
Practice Address - State:GA
Practice Address - Zip Code:31005
Practice Address - Country:US
Practice Address - Phone:478-988-1282
Practice Address - Fax:478-988-3120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-11
Last Update Date:2009-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA029061207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000374382KMedicaid
GA092100603DMedicaid
GA000374382KMedicaid
GA08BBQZVMedicare PIN
GA08BDDPFMedicare PIN