Provider Demographics
NPI:1760147805
Name:ELMOR, SAMMY T (BS)
Entity Type:Individual
Prefix:
First Name:SAMMY
Middle Name:T
Last Name:ELMOR
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2665 N DECATUR RD STE 330
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-6145
Mailing Address - Country:US
Mailing Address - Phone:404-297-9755
Mailing Address - Fax:
Practice Address - Street 1:2665 N DECATUR RD STE 330
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-6145
Practice Address - Country:US
Practice Address - Phone:404-297-9755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-03
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744R1102XOther Service ProvidersSpecialistResearch Study