Provider Demographics
NPI:1942333158
Name:SAMUELS, DAVID P (DO)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:P
Last Name:SAMUELS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 LESTER RD
Mailing Address - Street 2:
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30458-2119
Mailing Address - Country:US
Mailing Address - Phone:912-662-6501
Mailing Address - Fax:912-681-1012
Practice Address - Street 1:19 LESTER RD
Practice Address - Street 2:
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30458-2119
Practice Address - Country:US
Practice Address - Phone:912-662-6501
Practice Address - Fax:912-681-1012
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS147652084P0800X
GA0495212084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000895177AMedicaid
G85278Medicare UPIN
GA000895177AMedicaid