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NPI Code Detail

MEDICARE: SAMUEL CHASE

MEDICARE: SAMUEL CHASE
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
1225700000XMassage TherapistMT013863GA

General Provider Information

NPI Number : 1598413320
Entity Type Code : Individual
Provider Name (Legal Business Name) : SAMUEL CHASE
Provider Business Mailing Address
First Line : 5006 CHARLOTTE CT SE
Second Line :
City : SMYRNA
State : GA
Zip : 30082-4800
Country : US
Telephone Number : 678-882-2395
Fax Number :
Provider Business Practice Location Address
First Line : 5006 CHARLOTTE CT SE
Second Line :
City : SMYRNA
State : GA
Zip : 30082-4800
Country : US
Telephone Number : 678-882-2395
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/10/2022
Last Update Date : 03/10/2022

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Directions to “ SAMUEL CHASE ” Practice Location

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