MEDICARE: LANALEE A SAM MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	080226	GA

General Provider Information

NPI Number	:	1134195837
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LANALEE A SAM MD

Provider Business Mailing Address
First Line	:	750 TOWNPARK LN NW
Second Line	:
City	:	KENNESAW
State	:	GA
Zip	:	30144-5579
Country	:	US
Telephone Number	:	404-365-0966
Fax Number	:

Provider Business Practice Location Address
First Line	:	750 TOWNPARK LN NW
Second Line	:
City	:	KENNESAW
State	:	GA
Zip	:	30144-5579
Country	:	US
Telephone Number	:	404-365-0966
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/23/2006
Last Update Date	:	09/30/2024

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