Healthcare Provider Details

I. General information

NPI: 1538262167
Provider Name (Legal Business Name): SAMUEL DEUTSCH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2006
Last Update Date: 08/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 WEST PIKE STREET SUITE 100
LAWRENCEVILLE GA
30045
US

IV. Provider business mailing address

316 WEST PIKE STREET SUITE 100
LAWRENCEVILLE GA
30045
US

V. Phone/Fax

Practice location:
  • Phone: 770-682-8442
  • Fax: 770-682-8200
Mailing address:
  • Phone: 770-682-8442
  • Fax: 770-682-8200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036133
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: