Provider Demographics
NPI:1902975253
Name:SAMUELS, CAROL ANN (MS,DC)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:ANN
Last Name:SAMUELS
Suffix:
Gender:F
Credentials:MS,DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6085 LAKE FORREST DR NW
Mailing Address - Street 2:STE 300A
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-3892
Mailing Address - Country:US
Mailing Address - Phone:404-843-3040
Mailing Address - Fax:404-843-0119
Practice Address - Street 1:6085 LAKE FORREST DR NW
Practice Address - Street 2:STE 300A
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-3892
Practice Address - Country:US
Practice Address - Phone:404-843-3040
Practice Address - Fax:404-843-0119
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2331111N00000X
FL4812111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor