Provider Demographics
NPI:1487004651
Name:SAMPSON, JOSEPH LUTHER JR (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:LUTHER
Last Name:SAMPSON
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2705 SHANDY LN
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28409-2042
Mailing Address - Country:US
Mailing Address - Phone:910-612-0448
Mailing Address - Fax:
Practice Address - Street 1:2705 SHANDY LN
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28409-2042
Practice Address - Country:US
Practice Address - Phone:910-612-0448
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-17
Last Update Date:2016-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC16106261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder