Elizabeth Sam

Primary specialty

Primary Care Nurse PractitionerTaxonomy code 363LP2300X

License

F01180587 Issued in GA

Practice address

4025 Lawrenceville Hwy NW
Lilburn, GA 30047-3013

Phone

(770) 559-3501

NPI assigned

Apr 12, 2018

Sex

Female

Sole proprietor

No

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.

• Clarkston Primary & Urgent Care, LLC

  • Family Medicine Physician
  • Clarkston, GA
  • NPI 1043781420
  NPD (past)

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Oct 6, 2021.

{
    "created_epoch": "1523491200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1633478400000",
    "number": "1154828366",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1328 AVINGTON GLEN DR",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300453500",
            "telephone_number": "423-414-6926"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4025 LAWRENCEVILLE HWY NW",
            "city": "LILBURN",
            "state": "GA",
            "postal_code": "300473013",
            "telephone_number": "770-559-3501"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SAM",
        "first_name": "ELIZABETH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-04-12",
        "last_updated": "2021-10-06",
        "certification_date": "2021-10-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "GA",
            "license": "F01180587",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lakenya Ryan
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• Sage Psychiatric Professionals LLC
• Tinesha A Sallard, MS
• Donald E Sally, PA
• Dayanara Sanchez-Aveldanez
• Maria Carmen Santana, PHD
• Isabel Santiago
• Nesemio Santiago, D.C.
• Sas Ancillary Services LLC

• All providers in Lilburn, GA
• Primary Care Nurse Practitioner in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.