Provider Demographics
NPI:1609244987
Name:SAMPSON, JAMALA (RD)
Entity Type:Individual
Prefix:MRS
First Name:JAMALA
Middle Name:
Last Name:SAMPSON
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9030 GLENWATER DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-8563
Mailing Address - Country:US
Mailing Address - Phone:704-503-6900
Mailing Address - Fax:704-503-0303
Practice Address - Street 1:9030 GLENWATER DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-8563
Practice Address - Country:US
Practice Address - Phone:704-503-6900
Practice Address - Fax:704-503-0303
Is Sole Proprietor?:No
Enumeration Date:2015-09-03
Last Update Date:2015-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL004305133VN1005X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered