Provider Demographics
NPI:1447270806
Name:SAMUELS, OWEN B (MD)
Entity type:Individual
Prefix:
First Name:OWEN
Middle Name:B
Last Name:SAMUELS
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Gender:M
Credentials:MD
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Mailing Address - Street 1:1365 CLIFTON RD NE
Mailing Address - Street 2:SUITE B6100
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30322-1013
Mailing Address - Country:US
Mailing Address - Phone:404-778-3752
Mailing Address - Fax:404-778-4472
Practice Address - Street 1:1365 CLIFTON RD NE
Practice Address - Street 2:SUITE B6100
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322-1013
Practice Address - Country:US
Practice Address - Phone:404-778-3752
Practice Address - Fax:404-778-4472
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
GA434692084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAG84910Medicare UPIN