MEDICARE: DR. SAMANTHA LYN BOROUGHS 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	54794	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	:	1659385979
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SAMANTHA LYN BOROUGHS MD

Provider Business Mailing Address
First Line	:	400 BROOKSTONE CENTRE PKWY
Second Line	:	SUITE 200
City	:	COLUMBUS
State	:	GA
Zip	:	31904-3639
Country	:	US
Telephone Number	:	706-507-3332
Fax Number	:	706-507-3359

Provider Business Practice Location Address
First Line	:	400 BROOKSTONE CENTRE PKWY
Second Line	:	SUITE 200
City	:	COLUMBUS
State	:	GA
Zip	:	31904-3639
Country	:	US
Telephone Number	:	706-507-3332
Fax Number	:	706-507-3359

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

Provider Enumeration Date	:	07/29/2006
Last Update Date	:	03/07/2023

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