Organization
PEDIATRIC DIGESTIVE HEALTH AND WELLNESS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DERICA NICOLE SAMS MD (OWNER/ AUTHORIZED OFFICIAL)
(706) 340-4330
Entity
Organization
Contact information
Practice address
3925 HARRISON RD STE 100, LOGANVILLE, GA 30052-5898
(706) 340-4330
Mailing address
3925 HARRISON RD STE 100, LOGANVILLE, GA 30052-5898
(706) 340-4330
Taxonomy
Speciality
Code
Description
License number
State
2080P0206X
Pediatric Gastroenterology Physician
Primary
—
—
Other
Enumeration date
07/21/2023
Last updated
09/04/2024
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