Provider Demographics
NPI:1285963447
Name:SAMANA ZULU MD FACS LLC
Entity type:Organization
Organization Name:SAMANA ZULU MD FACS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JARMAUR
Authorized Official - Middle Name:R
Authorized Official - Last Name:STALLINGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-737-7922
Mailing Address - Street 1:2320 WRIGHTSBORO RD
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30904-6233
Mailing Address - Country:US
Mailing Address - Phone:706-737-7922
Mailing Address - Fax:706-737-7968
Practice Address - Street 1:2320 WRIGHTSBORO RD
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30904-6233
Practice Address - Country:US
Practice Address - Phone:706-737-7922
Practice Address - Fax:706-737-7968
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-17
Last Update Date:2009-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA059943208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty