Provider Demographics
NPI:1972555282
Name:ERINNE, SAMUEL C (MD)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:C
Last Name:ERINNE
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 1:1029 CLEVELAND AVE
Mailing Address - Street 2:
Mailing Address - City:EAST POINT
Mailing Address - State:GA
Mailing Address - Zip Code:30344-6719
Mailing Address - Country:US
Mailing Address - Phone:404-768-4626
Mailing Address - Fax:404-768-4631
Practice Address - Street 1:1029 CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:EAST POINT
Practice Address - State:GA
Practice Address - Zip Code:30344-6719
Practice Address - Country:US
Practice Address - Phone:404-768-4626
Practice Address - Fax:404-768-4631
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2012-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA035622207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00508483GMedicaid
GA11BDPGTMedicare ID - Type Unspecified
GA00508483GMedicaid