Provider Demographics
NPI:1083420061
Name:SAMUEL, REENU ABY (MSC)
Entity type:Individual
Prefix:MRS
First Name:REENU
Middle Name:ABY
Last Name:SAMUEL
Suffix:
Gender:F
Credentials:MSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:341 SKYLINE DR
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31757-2521
Mailing Address - Country:US
Mailing Address - Phone:229-380-6015
Mailing Address - Fax:
Practice Address - Street 1:341 SKYLINE DR
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:GA
Practice Address - Zip Code:31757-2521
Practice Address - Country:US
Practice Address - Phone:229-380-6015
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-05
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator