Provider Demographics
NPI:1386753564
Name:RICHWINE, SAM W JR (M D)
Entity type:Individual
Prefix:DR
First Name:SAM
Middle Name:W
Last Name:RICHWINE
Suffix:JR
Gender:M
Credentials:M D
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Mailing Address - Street 1:1296 SIMS ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501-3850
Mailing Address - Country:US
Mailing Address - Phone:770-534-1856
Mailing Address - Fax:770-531-0355
Practice Address - Street 1:1296 SIMS ST
Practice Address - Street 2:SUITE B
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-3850
Practice Address - Country:US
Practice Address - Phone:770-534-1856
Practice Address - Fax:770-531-0355
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
GA019761208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00193498DMedicaid
GA00193498DMedicaid