Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RH0000X | Hematologist | 89007 | GA |
Y | 207RX0202X | Medical Oncology | 89007 | GA |
NPI | 1104212778 |
---|---|
Provider Name | Devi Sampat |
First Address | Birmingham, AL 35249 |
Second Address | Gainesville, GA 30501-3834 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2015 |
Last Update Date | 07/07/2021 |