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General NPI Number Information
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NPI Number | 1073981999
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Entity Type | Organization
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Legal Business Name | DPS HEALTH AND WELLNESS
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Dates
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Enumeration Date | 09/09/2015
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Last Update Date | 09/22/2022
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Provider Practice Location Address
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Address Line | 19 COACH LEE HILL BLVD
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City | STATESBORO
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State | GA
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Zip | 30458-4700
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Country | US
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Telephone | 912-662-6501
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Fax | 912-681-1012
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Provider Business Mailing Address
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Address Line | 19 COACH LEE HILL BOULEVARD
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City | STATESBORO
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State | GA
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Zip | 30458-2119
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Country | US
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Telephone | 912-662-6501
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Fax | 912-681-1012
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Authorized Official
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Title or Position | OWNER
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Name | DR. DAVID SAMUELS
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Credential | DO
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Telephone | 912-662-6501
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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