Provider Demographics
NPI:1912978255
Name:SAMS, JOSEPH O IV
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:O
Last Name:SAMS
Suffix:IV
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8110 N BROTHER BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:TN
Mailing Address - Zip Code:38133-2760
Mailing Address - Country:US
Mailing Address - Phone:901-255-5221
Mailing Address - Fax:900-373-4511
Practice Address - Street 1:1204 MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655-5326
Practice Address - Country:US
Practice Address - Phone:662-236-5717
Practice Address - Fax:662-234-4016
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS17613207V00000X
ARE3732207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR148606001Medicaid
AR5M582OtherBLUE CROSS
AR148606001Medicaid
AR770282001OtherEDS BREASTCARE
AR3100011400OtherQUALCHOICE
7181709OtherCIGNA
P00035794OtherMEDICARE RAILROAD CARRIER
AS0140118OtherHUMANA TRICARE
P00035794OtherMEDICARE RAILROAD CARRIER