Provider Demographics
NPI:1386637189
Name:SAMSON, MARK J (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:J
Last Name:SAMSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:908 HILLCREST PKWY
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:GA
Mailing Address - Zip Code:31021-4206
Mailing Address - Country:US
Mailing Address - Phone:478-272-7411
Mailing Address - Fax:478-274-9809
Practice Address - Street 1:908 HILLCREST PKWY
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:GA
Practice Address - Zip Code:31021-4206
Practice Address - Country:US
Practice Address - Phone:478-272-7411
Practice Address - Fax:478-274-9809
Is Sole Proprietor?:No
Enumeration Date:2005-08-26
Last Update Date:2022-07-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA040776207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000718198DMedicaid
GAG38754Medicare UPIN
GA000718198DMedicaid