Provider Demographics
NPI:1225600745
Name:LOUISSAINT, SAMUEL ABDIAS
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:ABDIAS
Last Name:LOUISSAINT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 PAULOWNIA CIR
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-3092
Mailing Address - Country:US
Mailing Address - Phone:857-236-5600
Mailing Address - Fax:
Practice Address - Street 1:821 PAVILION CT STE A
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-6790
Practice Address - Country:US
Practice Address - Phone:770-321-1773
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-14
Last Update Date:2024-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2324549163W00000X
GARN311141363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No163W00000XNursing Service ProvidersRegistered Nurse