MEDICARE: SAMUEL O TENIOLA 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	207R00000X	Internal Medicine Physician	049349	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	:	1518965938
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMUEL O TENIOLA MD

Provider Business Mailing Address
First Line	:	945 LINSLEY WAY
Second Line	:
City	:	STONE MOUNTAIN
State	:	GA
Zip	:	30087-6083
Country	:	US
Telephone Number	:	770-879-9659
Fax Number	:

Provider Business Practice Location Address
First Line	:	285 BOULEVARD NE
Second Line	:	SUITE 435
City	:	ATLANTA
State	:	GA
Zip	:	30312-4205
Country	:	US
Telephone Number	:	404-524-8950
Fax Number	:

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

Provider Enumeration Date	:	07/10/2005
Last Update Date	:	07/08/2007

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Directions to “ SAMUEL O TENIOLA MD” Practice Location

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