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General NPI Number Information
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NPI Number | 1376098954
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Entity Type | Individual
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Provider Name | MR. TONY ANTHONY SAMPSON JR.
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Gender | Male
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Dates
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Enumeration Date | 08/24/2016
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Last Update Date | 12/19/2022
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Provider Practice Location Address
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Address Line | 2444 DALLAS HWY SW
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City | MARIETTA
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State | GA
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Zip | 30064-2529
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Country | US
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Telephone | 770-218-2763
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Fax | 770-218-3819
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Provider Business Mailing Address
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Address Line | 3236 MERCER UNIVERSITY DR APT 212
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City | ATLANTA
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State | GA
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Zip | 30341-5661
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Country | US
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Telephone | 229-834-8772
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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 | 183500000X
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Taxonomy Name | Pharmacist
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License Number | RPH029374
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License Number State | GA
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