MEDICARE: SAMUEL C ERINNE 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	035622	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	:	1972555282
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMUEL C ERINNE MD

Provider Business Mailing Address
First Line	:	1029 CLEVELAND AVE
Second Line	:
City	:	EAST POINT
State	:	GA
Zip	:	30344-6719
Country	:	US
Telephone Number	:	404-768-4626
Fax Number	:	404-768-4631

Provider Business Practice Location Address
First Line	:	1029 CLEVELAND AVE
Second Line	:
City	:	EAST POINT
State	:	GA
Zip	:	30344-6719
Country	:	US
Telephone Number	:	404-768-4626
Fax Number	:	404-768-4631

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

Provider Enumeration Date	:	05/16/2006
Last Update Date	:	07/25/2012

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