Healthcare Provider Details

I. General information

NPI: 1821429895
Provider Name (Legal Business Name): DAVID SAMS JR. PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2013
Last Update Date: 01/25/2022
Certification Date: 09/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 HEALTH CENTER DR
ATHENS OH
45701-2907
US

IV. Provider business mailing address

PO BOX 7527
DUBLIN OH
43017-0727
US

V. Phone/Fax

Practice location:
  • Phone: 740-592-7100
  • Fax: 740-592-7112
Mailing address:
  • Phone: 614-544-6155
  • Fax: 614-544-6370

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.005546RX
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number0010-04430
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: