Provider Demographics
NPI:1023302544
Name:MCELROY, SAMUEL DAVID PATRICK (MD)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:DAVID PATRICK
Last Name:MCELROY
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 1:4451 PAULSEN ST
Mailing Address - Street 2:SAVANNAH
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-3664
Mailing Address - Country:US
Mailing Address - Phone:912-350-7500
Mailing Address - Fax:912-350-7735
Practice Address - Street 1:4451 PAULSEN ST
Practice Address - Street 2:SAVANNAH
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-3664
Practice Address - Country:US
Practice Address - Phone:912-350-7500
Practice Address - Fax:912-350-7735
Is Sole Proprietor?:No
Enumeration Date:2011-06-01
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA072319207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003137659BMedicaid
GAP01366532OtherRAILROAD MEDICARE
GA20211I2200Medicare PIN