MEDICARE: SAMS EAST INC

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	333600000X	Pharmacy
2	332B00000X	Durable Medical Equipment & Medical Supplies
3	3336C0003X	Community/Retail Pharmacy	PHRE008605	GA

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
2	2014495	OTHER		PK

General Provider Information

NPI Number	:	1285651521
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAMS EAST INC

Provider Business Mailing Address
First Line	:	1 CUSTOMER DR
Second Line	:	MS 0445
City	:	BENTONVILLE
State	:	AR
Zip	:	72716-0445
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4365 ATLANTA HWY
Second Line	:
City	:	ATHENS
State	:	GA
Zip	:	30606-0808
Country	:	US
Telephone Number	:	706-548-1913
Fax Number	:

Authorized Official
Title or Position	:	SENIOR DIRECTOR, ENROLLMENT
Name	:	KIMBERLY CANONIC
Credential	:
Telephone Number	:	480-853-0515

Provider Enumeration Date	:	07/16/2006
Last Update Date	:	06/15/2026

Similar Medicare Providers

1578652194 — SAM'S EAST INC
Practice Location Address:

4365 ATLANTA HWY
ATHENS, GA
30606-0808

Practice Phone: 706-548-2824
Practice Fax: 706-548-9676

1629678610 — CRYSTAL WINGFIELD PHARMD
Practice Location Address:

4365 ATLANTA HWY
ATHENS, GA
30606-0808

Practice Phone: 706-548-1913
Practice Fax: 706-548-2481

1013518588 — YVONNE H ALMOND
Practice Location Address:

4365 ATLANTA HWY
ATHENS, GA
30606-0808

Practice Phone: 706-548-1913
Practice Fax: 706-548-2481

1457180044 — KIMBERLY MARLENE JOHNSTON
Practice Location Address:

4365 ATLANTA HWY
ATHENS, GA
30606-0808

Practice Phone: 706-548-2824
Practice Fax: 706-548-2481

1972438836 — DR. WONDIMAGEGN TIBEBU TILAHUN MD
Practice Location Address:

1199 PRINCE AVE
ATHENS, GA
30606-2797

Practice Phone: 706-475-7000
Practice Fax:

1801721642 — MALLORY JORDAN VEILLETTE CSTFA
Practice Location Address:

1199 PRINCE AVE
ATHENS, GA
30606-2797

Practice Phone: 706-613-5880
Practice Fax: 706-613-5889

Directions to “SAMS EAST INC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.