Elizabeth Sam
Nurse Practitioner, Primary Care in Lilburn, GA. Individual provider (NPI-1).
NPI number1154828366
StatusActive
Last updated in NPPESOct 6, 2021
Details
- NPI
- 1154828366
- Entity type
- Individual (NPI-1)
- Name
- Elizabeth Sam
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Apr 12, 2018
- Certification date
- Oct 6, 2021
- Last updated
- Oct 6, 2021
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363LP2300X | Nurse Practitioner, Primary Care | F01180587 | GA | Yes |
Practice location
4025 Lawrenceville Hwy NwLilburn, GA 30047-3013
Phone 770-559-3501
Mailing address
1328 Avington Glen DrLawrenceville, GA 30045-3500
Phone 423-414-6926
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