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General NPI Number Information
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NPI Number | 1720778301
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Entity Type | Individual
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Provider Name | SAMUEL SARPONG
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Gender | Male
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Dates
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Enumeration Date | 05/09/2023
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Last Update Date | 01/22/2026
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Provider Practice Location Address
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Address Line | 881 USS JAMES MADISON RD
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City | KINGS BAY
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State | GA
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Zip | 31547-2531
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Country | US
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Telephone | 912-573-4264
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Fax | 912-573-2532
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Provider Business Mailing Address
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Address Line | 1740 MEMORIAL DR
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City | WAYCROSS
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State | GA
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Zip | 31501-1044
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Country | US
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Telephone | 240-418-4142
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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 | RPH029715
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License Number State | GA
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