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General NPI Number Information
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NPI Number | 1043442080
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Entity Type | Organization
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Legal Business Name | SAM PENG MD PC
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Dates
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Enumeration Date | 08/10/2009
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Last Update Date | 08/10/2009
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Provider Practice Location Address
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Address Line | 1622 RIVERGREEN BND SE
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City | ATLANTA
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State | GA
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Zip | 30339-8546
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Country | US
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Telephone | 770-587-5485
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Fax |
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Provider Business Mailing Address
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Address Line | 1622 RIVERGREEN BND SE
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City | ATLANTA
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State | GA
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Zip | 30339-8546
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Country | US
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Telephone | 770-587-5485
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | SAM Q PENG
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Credential | M.D.
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Telephone | 770-820-3855
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QG0300X
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Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
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License Number | 057232
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License Number State | GA
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