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General NPI Number Information
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NPI Number | 1376704106
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Entity Type | Organization
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Legal Business Name | SAMUEL DEUTSCH MD PC
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Dates
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Enumeration Date | 06/24/2008
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Last Update Date | 06/24/2008
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Provider Practice Location Address
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Address Line | 316 W PIKE ST STE 100
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City | LAWRENCEVILLE
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State | GA
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Zip | 30045-4878
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Country | US
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Telephone | 770-682-8442
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Fax | 770-682-8200
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Provider Business Mailing Address
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Address Line | 316 W PIKE ST STE 100
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City | LAWRENCEVILLE
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State | GA
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Zip | 30045-4878
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Country | US
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Telephone | 770-682-8442
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Fax | 770-682-8200
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Authorized Official
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Title or Position | OWNER
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Name | DR. SAMUEL DEUTSCH
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Credential | MD
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Telephone | 770-682-8442
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 036133
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License Number State | GA
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