Healthcare Provider Details

I. General information

NPI: 1770901530
Provider Name (Legal Business Name): SAMUEL KEY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2014
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1906 BELLEVIEW AVE SE
ROANOKE VA
24014-1838
US

IV. Provider business mailing address

2003 N CROSSING WAY
DECATUR GA
30033-4173
US

V. Phone/Fax

Practice location:
  • Phone: 800-422-8482
  • Fax:
Mailing address:
  • Phone: 540-816-9164
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number0101290101
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number82933
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: