Provider Demographics
NPI:1952667719
Name:CAREY-SAMUELS, VELMA D
Entity Type:Individual
Prefix:
First Name:VELMA
Middle Name:D
Last Name:CAREY-SAMUELS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8075 MALL PKWY
Mailing Address - Street 2:STE. 101-334
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30038-6993
Mailing Address - Country:US
Mailing Address - Phone:678-508-1935
Mailing Address - Fax:770-323-1983
Practice Address - Street 1:8075 MALL PKWY
Practice Address - Street 2:STE. 101-334
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30038-6993
Practice Address - Country:US
Practice Address - Phone:678-508-1935
Practice Address - Fax:770-323-1983
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-05
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA743527131AMedicaid