Provider Demographics
NPI:1013443480
Name:SAMS, DERICA NICOLE (MD)
Entity type:Individual
Prefix:DR
First Name:DERICA
Middle Name:NICOLE
Last Name:SAMS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3925 HARRISON RD STE 100
Mailing Address - Street 2:
Mailing Address - City:LOGANVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30052-5898
Mailing Address - Country:US
Mailing Address - Phone:770-274-4222
Mailing Address - Fax:770-284-3187
Practice Address - Street 1:3925 HARRISON RD STE 100
Practice Address - Street 2:
Practice Address - City:LOGANVILLE
Practice Address - State:GA
Practice Address - Zip Code:30052-5898
Practice Address - Country:US
Practice Address - Phone:770-274-4222
Practice Address - Fax:770-284-3187
Is Sole Proprietor?:No
Enumeration Date:2017-05-04
Last Update Date:2025-01-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC227179208000000X
GA972292080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics