Provider Demographics
NPI:1982470597
Name:SAMS, DONZALEIGHA
Entity Type:Individual
Prefix:
First Name:DONZALEIGHA
Middle Name:
Last Name:SAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:149 OAKHILL CEMETERY RD
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31017-1750
Mailing Address - Country:US
Mailing Address - Phone:478-319-9257
Mailing Address - Fax:
Practice Address - Street 1:2249 VINSON HWY SE
Practice Address - Street 2:
Practice Address - City:MILLEDGEVILLE
Practice Address - State:GA
Practice Address - Zip Code:31061-4807
Practice Address - Country:US
Practice Address - Phone:478-445-6829
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-27
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOTA002080224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant