Provider Demographics
NPI:1134387822
Name:SAM, GINA (MD)
Entity type:Individual
Prefix:DR
First Name:GINA
Middle Name:
Last Name:SAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:GINA
Other - Middle Name:
Other - Last Name:SAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2300 MANCHESTER EXPY STE A201
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-6856
Mailing Address - Country:US
Mailing Address - Phone:917-513-9410
Mailing Address - Fax:
Practice Address - Street 1:2300 MANCHESTER EXPY STE A201
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-6856
Practice Address - Country:US
Practice Address - Phone:706-320-2766
Practice Address - Fax:706-250-5675
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-29
Last Update Date:2024-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI101198207RG0100X
NY240112207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology