Individual
SAM SECORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1000 JOHNSON FY RD NE, ATLANTA, GA 30342-1606
(404) 851-8000
Mailing address
57 EXECUTIVE PARK S STE 300, ATLANTA, GA 30329-2287
(404) 727-5910
Taxonomy
Speciality
Code
Description
License number
State
367H00000X
Anesthesiologist Assistant
Primary
11587
GA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/19/2021
Last updated
04/28/2023
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