Provider Demographics
NPI:1922352517
Name:MCALLISTER, SAMUEL NATHANIEL (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:NATHANIEL
Last Name:MCALLISTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5745 LAWRENCEVILLE HWY
Mailing Address - Street 2:
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-1919
Mailing Address - Country:US
Mailing Address - Phone:770-717-5010
Mailing Address - Fax:770-717-9831
Practice Address - Street 1:5745 LAWRENCEVILLE HWY
Practice Address - Street 2:
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-1919
Practice Address - Country:US
Practice Address - Phone:770-717-5010
Practice Address - Fax:770-717-9831
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-03
Last Update Date:2012-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA029210132700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes132700000XDietary & Nutritional Service ProvidersDietary Manager