Provider Demographics
NPI:1306008966
Name:CAROL A. SAMUELS DC PC
Entity type:Organization
Organization Name:CAROL A. SAMUELS DC PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:SAMUELS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:404-843-3040
Mailing Address - Street 1:4840 ROSWELL RD NE
Mailing Address - Street 2:SUITE C-100
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-2639
Mailing Address - Country:US
Mailing Address - Phone:404-843-3040
Mailing Address - Fax:
Practice Address - Street 1:4840 ROSWELL RD NE
Practice Address - Street 2:SUITE C-100
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-2639
Practice Address - Country:US
Practice Address - Phone:404-843-3040
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-25
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIROO2331111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA142384307AMedicare UPIN