Individual
DR. SAMUEL LEROY CHURCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
85 SEASONS LANE, HIAWASSEE, GA 30546-3217
(706) 896-0505
(866) 796-2502
Mailing address
PO 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
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000901271D
—
GA
01
—
002342
BLUE CROSS BLUE SHIELD
GA
05
—
89066J3
—
NC
01
—
930122977
MEDICARE RAILROAD
GA
Enumeration date
12/29/2005
Last updated
03/05/2014
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