Derica N. Sams, M.D.

Primary specialty

Pediatric Gastroenterology PhysicianTaxonomy code 2080P0206X

License

97229 Issued in GA

Practice address

3925 Harrison Rd Ste 100
Loganville, GA 30052-5898

Phone

(770) 274-4222

Fax

(770) 284-3187

NPI assigned

May 4, 2017

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/25384/brand/1/csg/1/fhir/r4
• Direct secure messaging: dsams572926@direct.vumc.org

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Pediatric Digestive Health and Wellness

  • Pediatric Gastroenterology Physician
  • Loganville, GA
  • NPI 1083394266
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1493856000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1785369600000",
    "number": "1013443480",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3925 HARRISON RD STE 100",
            "city": "LOGANVILLE",
            "state": "GA",
            "postal_code": "300525898",
            "telephone_number": "770-274-4222",
            "fax_number": "770-284-3187"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3925 HARRISON RD STE 100",
            "city": "LOGANVILLE",
            "state": "GA",
            "postal_code": "300525898",
            "telephone_number": "770-274-4222",
            "fax_number": "770-284-3187"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SAMS",
        "first_name": "DERICA",
        "middle_name": "N.",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-05-04",
        "last_updated": "2026-07-30",
        "certification_date": "2026-07-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NC",
            "license": "227179",
            "primary": false
        },
        {
            "code": "2080P0206X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Gastroenterology",
            "state": "GA",
            "license": "97229",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Marianna Vladimirovna Russu, R.T.(R)
• Rutledge Pharmacy and Medical Supplies LLC
• Sacredspace Psychotherapy, LLC
• Sage Dental Group of Georgia, LLC
• Denise Nabouro Samassa
• Samuel S Kwon - Loganville DMD PC
• Kathryn Cook Sanders, IBCLC, CLC
• Sanjeev S Tendolkar MD LLC
• Aliu O Sanni, MD
• Lady Sarfo, PHARMD

• Pediatric Gastroenterology Physician in Loganville, GA
• Providers in Loganville, GA by specialty
• Pediatric Gastroenterology Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.