Individual
HASAN SAMRA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1120 15TH ST, AUGUSTA, GA 30912-3548
(706) 721-8623
Mailing address
1120 15TH ST, AUGUSTA, GA 30912-0004
(706) 721-8623
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
88522
GA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
88522
GA MEDICAL LICENSE
GA
Enumeration date
03/22/2016
Last updated
04/16/2021
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