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General NPI Number Information
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NPI Number | 1306069380
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Entity Type | Individual
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Provider Name | WINSTON L SAMUELS MD
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Gender | Male
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Dates
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Enumeration Date | 04/10/2007
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Last Update Date | 09/05/2024
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Provider Practice Location Address
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Address Line | 1846 OLD NORCROSS RD STE 100
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City | LAWRENCEVILLE
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State | GA
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Zip | 30044-8801
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Country | US
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Telephone | 404-738-7878
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Fax | 404-999-4968
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Provider Business Mailing Address
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Address Line | 1846 OLD NORCROSS RD STE 100
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City | LAWRENCEVILLE
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State | GA
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Zip | 30044-8801
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Country | US
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Telephone | 404-738-7878
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Fax | 770-736-7134
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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 | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 060867
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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 | 60867
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License Number State | GA
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