Individual
DISNEY KULACHATI SAMUTSAKORN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
2817 ROCK MERRITT AVE, FORT BRAGG, NC 28310-4504
(910) 907-8922
(910) 907-6069
Mailing address
2817 REILLY ST, FORT BRAGG, NC 28310-7324
(910) 907-6000
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1138817
NC
Other
Enumeration date
12/05/2016
Last updated
11/17/2025
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