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Individual

ROY OLIVER SAMUELS

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
1385 TRAVERS CREEK TRL, CONYERS, GA 30012-3581
(718) 807-7058
Mailing address
1385 TRAVERS CREEK TRL, CONYERS, GA 30012-3581
(718) 807-7058

Taxonomy

Speciality
Code
Description
License number
State
347C00000X
Private Vehicle
Primary
057718186
GA

Other

Enumeration date
11/30/2011
Last updated
11/30/2011
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