MEDICARE: SAMPSON OBGYN PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician		NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144386962
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAMPSON OBGYN PA

Provider Business Mailing Address
First Line	:	417 VANCE ST
Second Line	:	SUITE 200
City	:	CLINTON
State	:	NC
Zip	:	28328-4001
Country	:	US
Telephone Number	:	910-592-1112
Fax Number	:	910-592-3539

Provider Business Practice Location Address
First Line	:	417 VANCE ST
Second Line	:	SUITE 200
City	:	CLINTON
State	:	NC
Zip	:	28328-4001
Country	:	US
Telephone Number	:	910-592-1112
Fax Number	:	910-592-3539

Authorized Official
Title or Position	:	PRESIDENT
Name	:	RHONDA WASHINGTON
Credential	:	MD
Telephone Number	:	910-592-1112

Provider Enumeration Date	:	12/28/2006
Last Update Date	:	08/22/2020

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Directions to “SAMPSON OBGYN PA ” Practice Location

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