MEDICARE: DR. GINA 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	207RG0100X	Gastroenterology Physician	101198	WI
2	207RG0100X	Gastroenterology Physician	240112	NY

General Provider Information

NPI Number	:	1134387822
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GINA SAM MD

Provider Business Mailing Address
First Line	:	2300 MANCHESTER EXPY STE A201
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31904-6856
Country	:	US
Telephone Number	:	917-513-9410
Fax Number	:

Provider Business Practice Location Address
First Line	:	2300 MANCHESTER EXPY STE A201
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31904-6856
Country	:	US
Telephone Number	:	706-320-2766
Fax Number	:	706-250-5675

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

Provider Enumeration Date	:	05/29/2008
Last Update Date	:	05/24/2024

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