Healthcare Provider Details

I. General information

NPI: 1588686323
Provider Name (Legal Business Name): SAMUEL HUNTER M.D.,PH. D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 04/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3360 BUENA VISTA RD SUITE #8
COLUMBUS GA
31906-4265
US

IV. Provider business mailing address

PO BOX 132
COLUMBUS GA
31902-0132
US

V. Phone/Fax

Practice location:
  • Phone: 706-324-6474
  • Fax: 706-682-4981
Mailing address:
  • Phone: 706-324-6474
  • Fax: 706-682-4982

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number050382
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: