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Individual

SAMANTHA S WYATT

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
M.D.

Contact information

Practice address
620 WALNUT ST NE, SUITE A, DECATUR, AL 35601-2456
(256) 353-7775
(256) 353-7765
Mailing address
620 WALNUT ST NE, SUITE A, DECATUR, AL 35601-2456
(256) 353-7775
(256) 353-7765

Taxonomy

Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
00026547
AL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
009932289
AL
01
51001088
BCBS AL PROVIDER#
AL
05
529924440
AL
Enumeration date
05/31/2006
Last updated
12/18/2013
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