Provider Demographics
NPI:1447573845
Name:WINDER INTERNAL MEDICINE AND GERIATRICS CENTER PC
Entity Type:Organization
Organization Name:WINDER INTERNAL MEDICINE AND GERIATRICS CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RASHA
Authorized Official - Middle Name:G
Authorized Official - Last Name:AL SAMARA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-586-0310
Mailing Address - Street 1:30 SATELLITE DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WINDER
Mailing Address - State:GA
Mailing Address - Zip Code:30680-6211
Mailing Address - Country:US
Mailing Address - Phone:770-586-0310
Mailing Address - Fax:770-586-0312
Practice Address - Street 1:30 SATELLITE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:WINDER
Practice Address - State:GA
Practice Address - Zip Code:30680-6211
Practice Address - Country:US
Practice Address - Phone:770-586-0310
Practice Address - Fax:770-586-0312
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-12
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA063592207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA063592OtherMEDICAL LICENSE