Provider Demographics
NPI:1659557122
Name:ROLLEY, SAMUEL THOMAS (CNMT)
Entity Type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:THOMAS
Last Name:ROLLEY
Suffix:
Gender:M
Credentials:CNMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 514
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-0514
Mailing Address - Country:US
Mailing Address - Phone:912-604-3889
Mailing Address - Fax:
Practice Address - Street 1:795 N BELAIR RD
Practice Address - Street 2:
Practice Address - City:EVANS
Practice Address - State:GA
Practice Address - Zip Code:30809-4258
Practice Address - Country:US
Practice Address - Phone:912-604-3889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-15
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0223952471N0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471N0900XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistNuclear Medicine Technology