Provider Demographics
NPI:1912964586
Name:RAWLS, SAMUEL T (MD)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:T
Last Name:RAWLS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3008-A S. FLETCHER AVE.
Mailing Address - Street 2:
Mailing Address - City:FERNANDINA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32034-4597
Mailing Address - Country:US
Mailing Address - Phone:912-270-1981
Mailing Address - Fax:904-530-2296
Practice Address - Street 1:3008A S FLETCHER AVE
Practice Address - Street 2:
Practice Address - City:FERNANDINA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32034-4597
Practice Address - Country:US
Practice Address - Phone:912-270-1981
Practice Address - Fax:904-530-2296
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2025-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME139183207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000692898AMedicaid
GAC64750Medicare UPIN
GA000692898AMedicaid