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General NPI Number Information
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NPI Number | 1114716990
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Entity Type | Individual
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Provider Name | SAMUEL THOMAS LANDOCH MD
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Gender | Male
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Dates
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Enumeration Date | 05/06/2025
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Last Update Date | 05/06/2025
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Provider Practice Location Address
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Address Line | 1120 15TH ST
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City | AUGUSTA
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State | GA
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Zip | 30912-0004
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Country | US
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Telephone | 706-721-7005
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Fax |
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Provider Business Mailing Address
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Address Line | 1701 GOODRICH ST APT 1424
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City | AUGUSTA
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State | GA
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Zip | 30904-3054
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Country | US
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Telephone |
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 17511
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License Number State | GA
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