Provider Demographics
NPI:1962865436
Name:EFFOE, VALERY SAMMAH (MD, MS)
Entity Type:Individual
Prefix:DR
First Name:VALERY
Middle Name:SAMMAH
Last Name:EFFOE
Suffix:
Gender:M
Credentials:MD, MS
Other - Prefix:DR
Other - First Name:VALERY
Other - Middle Name:
Other - Last Name:EFFOE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD, MS
Mailing Address - Street 1:1602 VERNON RD STE 300
Mailing Address - Street 2:
Mailing Address - City:LAGRANGE
Mailing Address - State:GA
Mailing Address - Zip Code:30240-4129
Mailing Address - Country:US
Mailing Address - Phone:706-242-5100
Mailing Address - Fax:706-812-2454
Practice Address - Street 1:1602 VERNON RD STE 300
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:GA
Practice Address - Zip Code:30240-4129
Practice Address - Country:US
Practice Address - Phone:706-242-5100
Practice Address - Fax:706-812-2454
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-01
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA82593207R00000X, 207RI0011X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program