Individual
SAMUEL FAIRBANKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
6600 VAN AALST BLVD, FORT MOORE, GA 31905-2102
(762) 408-2001
Mailing address
6600 VAN AALST BLVD, FORT MOORE, GA 31905-2102
(762) 408-2001
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
0102205769
VA
Other
Enumeration date
02/20/2018
Last updated
08/01/2023
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