Provider Demographics
NPI:1124889696
Name:SAMS, EMALEIGH CIEARA
Entity type:Individual
Prefix:MRS
First Name:EMALEIGH
Middle Name:CIEARA
Last Name:SAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 BERT COMBS LAKE RD
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:KY
Mailing Address - Zip Code:40962-6113
Mailing Address - Country:US
Mailing Address - Phone:606-813-6456
Mailing Address - Fax:
Practice Address - Street 1:209 BERT COMBS LAKE RD
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:KY
Practice Address - Zip Code:40962-6113
Practice Address - Country:US
Practice Address - Phone:606-813-6456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-22
Last Update Date:2024-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1222437207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine