Provider Demographics
NPI:1811059157
Name:RAPER, SAMUEL HADEN (MED, MS)
Entity type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:HADEN
Last Name:RAPER
Suffix:
Gender:M
Credentials:MED, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:3432 WATER VISTAS PKWY
Mailing Address - Street 2:APT B
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30044-3070
Mailing Address - Country:US
Mailing Address - Phone:770-381-5498
Mailing Address - Fax:
Practice Address - Street 1:5030 GEORGIA BELLE CT
Practice Address - Street 2:STE 2036
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30093-2667
Practice Address - Country:US
Practice Address - Phone:770-638-5760
Practice Address - Fax:770-638-5789
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor