Provider Demographics
NPI:1598762627
Name:SONG, SAMUEL H (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:H
Last Name:SONG
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3435 DULUTH PARK LN
Mailing Address - Street 2:SUITE A
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-3259
Mailing Address - Country:US
Mailing Address - Phone:678-417-0407
Mailing Address - Fax:678-417-2008
Practice Address - Street 1:3435 DULUTH PARK LN
Practice Address - Street 2:SUITE A
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-3259
Practice Address - Country:US
Practice Address - Phone:678-417-0407
Practice Address - Fax:678-417-2008
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2011-09-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA049206208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000892207CMedicaid
GA000892207CMedicaid