Individual
ELIZABETH SAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4025 LAWRENCEVILLE HWY NW, LILBURN, GA 30047-3013
(770) 559-3501
Mailing address
1328 AVINGTON GLEN DR, LAWRENCEVILLE, GA 30045-3500
(423) 414-6926
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary
F01180587
GA
Other
Enumeration date
04/12/2018
Last updated
10/06/2021
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