Provider Demographics
NPI:1588686323
Name:HUNTER, SAMUEL (MD,PH D)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:
Last Name:HUNTER
Suffix:
Gender:M
Credentials:MD,PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 132
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31902-0132
Mailing Address - Country:US
Mailing Address - Phone:706-324-6474
Mailing Address - Fax:706-682-4982
Practice Address - Street 1:3360 BUENA VISTA RD
Practice Address - Street 2:SUITE #8
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31906-4265
Practice Address - Country:US
Practice Address - Phone:706-324-6474
Practice Address - Fax:706-682-4981
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2011-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA050382207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00926956AMedicaid
GAD64648Medicare UPIN
GA00926956AMedicaid
GA202I116719Medicare PIN