Healthcare Provider Details

I. General information

NPI: 1275966756
Provider Name (Legal Business Name): MR. SAMUEL PARKS HUGHES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2013
Last Update Date: 10/24/2023
Certification Date: 10/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1428 DUNWOODY VILLAGE PKWY
DUNWOODY GA
30338-4123
US

IV. Provider business mailing address

49 JESSE HILL JR DR SE
ATLANTA GA
30303-3049
US

V. Phone/Fax

Practice location:
  • Phone: 770-394-3258
  • Fax: 770-394-3055
Mailing address:
  • Phone: 404-778-1440
  • Fax: 404-778-1401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number85532
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: