Organization
SAMUEL L. CHURCH, MD, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SAMUEL L CHURCH MD (OWNER)
(706) 896-0505
Entity
Organization
Contact information
Practice address
85 SEASONS LANE, HIAWASSEE, GA 30546
(706) 896-0505
(866) 796-2502
Mailing address
P.O. BOX 1217, HIAWASSEE, GA 30546-1217
(706) 896-0505
(866) 796-2502
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
048990
GA
305R00000X
Preferred Provider Organization
048990
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000901271D
—
GA
05
—
89066J3
—
NC
Enumeration date
02/21/2007
Last updated
02/29/2016
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