NPI Code Detail JSON Logo

1659163335 NPI number — CHERYL SUSAN SAM

NPI Number: 1659163335
Health Care Provider/Practitioner: CHERYL SUSAN SAM

Information about “1659163335” NPI (CHERYL SUSAN SAM) exists in 1659163335 in HTML format HTML  |  1659163335 in plain Text format TXT  |  1659163335 in PDF (Portable Document Format) PDF  |  1659163335 in an XML format XML  formats.

NPI Number : 1659163335 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1659163335",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "SAM",
    "FirstName": "CHERYL",
    "MiddleName": "SUSAN",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "3110 WELLBROOK DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "LOGANVILLE",
    "MailingAddressStateName": "GA",
    "MailingAddressPostalCode": "30052-4996",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "770-862-8477",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "841 PRUDENTIAL DR",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "JACKSONVILLE",
    "PracticeLocationAddressStateName": "FL",
    "PracticeLocationAddressPostalCode": "32207-8329",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "404-862-4654",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "05/20/2025",
    "LastUpdateDate": "05/20/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "363A00000X",
        "TaxonomyName": "Physician Assistant",
        "LicenseNumber": "12894",
        "LicenseNumberStateCode": "GA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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