MEDICARE: WINSTON L SAMUELS 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	208D00000X	General Practice Physician	060867	GA
2	207Q00000X	Family Medicine Physician	60867	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306069380
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WINSTON L SAMUELS MD

Provider Business Mailing Address
First Line	:	1846 OLD NORCROSS RD STE 100
Second Line	:
City	:	LAWRENCEVILLE
State	:	GA
Zip	:	30044-8801
Country	:	US
Telephone Number	:	404-738-7878
Fax Number	:	770-736-7134

Provider Business Practice Location Address
First Line	:	1846 OLD NORCROSS RD STE 100
Second Line	:
City	:	LAWRENCEVILLE
State	:	GA
Zip	:	30044-8801
Country	:	US
Telephone Number	:	404-738-7878
Fax Number	:	404-999-4968

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

Provider Enumeration Date	:	04/10/2007
Last Update Date	:	09/05/2024

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Directions to “ WINSTON L SAMUELS MD” Practice Location

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