Provider Demographics
NPI:1609039965
Name:MICHAELS, SAMUEL JONATHAN (PA C)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:JONATHAN
Last Name:MICHAELS
Suffix:
Gender:M
Credentials:PA C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1121 CORNELL AVE
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-2701
Mailing Address - Country:US
Mailing Address - Phone:912-355-4987
Mailing Address - Fax:912-353-7257
Practice Address - Street 1:1121 CORNELL AVE
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-2701
Practice Address - Country:US
Practice Address - Phone:912-355-4987
Practice Address - Fax:912-353-7257
Is Sole Proprietor?:No
Enumeration Date:2008-07-08
Last Update Date:2009-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA5350363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant