Provider Demographics
NPI:1528083151
Name:SAMUEL, GEORGE A (DO)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:A
Last Name:SAMUEL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:110 DUNHILL PL NW
Mailing Address - Street 2:SUITE B
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37311-3866
Mailing Address - Country:US
Mailing Address - Phone:423-339-2000
Mailing Address - Fax:423-339-2043
Practice Address - Street 1:110 DUNHILL PL NW
Practice Address - Street 2:SUITE B
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37311-3866
Practice Address - Country:US
Practice Address - Phone:423-339-2000
Practice Address - Fax:423-339-2043
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2012-06-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TN2102207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNH22602Medicare UPIN