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General NPI Number Information
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NPI Number | 1053774018
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Entity Type | Individual
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Provider Name | SAMUEL WALING
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Gender | Male
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Dates
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Enumeration Date | 03/29/2016
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Last Update Date | 12/19/2023
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Provider Practice Location Address
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Address Line | 1650 SLAUGHTER RD STE A
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City | MADISON
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State | AL
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Zip | 35758-8610
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Country | US
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Telephone | 256-325-3646
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Fax | 256-325-3647
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Provider Business Mailing Address
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Address Line | 204 N WESTOVER BLVD
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City | ALBANY
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State | GA
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Zip | 31707-2983
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Country | US
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Telephone | 229-888-6559
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 83891
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | IP1540
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License Number State | KY
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | DO.3471
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License Number State | AL
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