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General NPI Number Information
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NPI Number | 1659385979
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Entity Type | Individual
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Provider Name | SAMANTHA LYN BOROUGHS MD
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Gender | Female
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Dates
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Enumeration Date | 07/29/2006
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 400 BROOKSTONE CENTRE PKWY SUITE 200
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City | COLUMBUS
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State | GA
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Zip | 31904-3639
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Country | US
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Telephone | 706-507-3332
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Fax | 706-507-3359
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Provider Business Mailing Address
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Address Line | 400 BROOKSTONE CENTRE PKWY SUITE 200
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City | COLUMBUS
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State | GA
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Zip | 31904-3639
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Country | US
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Telephone | 706-507-3332
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Fax | 706-507-3359
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 54794
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License Number State | GA
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