Healthcare Provider Details

I. General information

NPI: 1003220708
Provider Name (Legal Business Name): SAMUEL GREGORY HOOKS PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2014
Last Update Date: 06/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10929 US HIGHWAY 301 S STE 111
STATESBORO GA
30458-7774
US

IV. Provider business mailing address

10929 US HIGHWAY 301 S STE 111
STATESBORO GA
30458-7774
US

V. Phone/Fax

Practice location:
  • Phone: 912-764-7839
  • Fax: 912-489-1519
Mailing address:
  • Phone: 912-764-7839
  • Fax: 912-489-1519

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number021673
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: