Healthcare Provider Details

I. General information

NPI: 1316573223
Provider Name (Legal Business Name): SAMUEL SCOTT DACUS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2020
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

312 CATAWBA TRL
LEXINGTON SC
29072-9570
US

IV. Provider business mailing address

470 NORTHSIDE CHEROKEE BLVD STE 230
CANTON GA
30115-8029
US

V. Phone/Fax

Practice location:
  • Phone: 803-730-4651
  • Fax:
Mailing address:
  • Phone: 770-924-9656
  • Fax: 770-721-9461

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number112244
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: