MEDICARE: DR. SAMUEL W. MIETLING M.D.

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	2085N0700X	Neuroradiology Physician	051686	GA
2	2085R0202X	Diagnostic Radiology Physician	051686	GA
3	2085U0001X	Diagnostic Ultrasound Physician	051686	GA
4	2085R0204X	Vascular & Interventional Radiology Physician	051686	GA
5	2085R0204X	Vascular & Interventional Radiology Physician	ME49311	FL
6	2085N0904X	Nuclear Radiology Physician	051686	GA
7	2085D0003X	Diagnostic Neuroimaging (Radiology) Physician	051686	GA
8	2085B0100X	Body Imaging Physician	051686	GA
9	2085R0202X	Diagnostic Radiology Physician	ME49311	FL
10	2085P0229X	Pediatric Radiology Physician	051686	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	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	1346357217	OTHER		NPI - VASCULAR RADIOLOGY
5	83555	OTHER	SC	SC MEDICAL LICENSE
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1750347589
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SAMUEL W. MIETLING M.D.

Provider Business Mailing Address
First Line	:	PO BOX 3129
Second Line	:
City	:	AUGUSTA
State	:	GA
Zip	:	30914-3129
Country	:	US
Telephone Number	:	706-737-4575
Fax Number	:	706-731-5289

Provider Business Practice Location Address
First Line	:	2416 DUNN AVENUE
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32218-1015
Country	:	US
Telephone Number	:	904-353-3664
Fax Number	:	904-353-3858

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/21/2006
Last Update Date	:	11/18/2025

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