Samuel J Gold, MD

Primary specialty

Pediatric Clinical & Laboratory Immunology PhysicianTaxonomy code 2080I0007X

License

044468 Issued in GA

Practice address

1120 Wellstar Way Ste 201
Holly Springs, GA 30114

Phone

(770) 517-1900

Fax

(770) 999-2506

NPI assigned

Oct 21, 2005

Last updated

Oct 3, 2019By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in GA

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

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

• Wellstar Medical Group, LLC

  dba WellStar Family Medicine ACW

  • Family Medicine Physician
  • Kennesaw, GA
  • NPI 1558664003
  Medicare reassignment NPD
• Wellstar Medical Group, LLC

  • Multi-Specialty Clinic/Center
  • Marietta, GA
  • NPI 1275992240
  NPD

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

{
    "created_epoch": "1129852800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1570060800000",
    "number": "1295725208",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1120 WELLSTAR WAY STE 201",
            "city": "HOLLY SPRINGS",
            "state": "GA",
            "postal_code": "301148929",
            "telephone_number": "770-517-1900",
            "fax_number": "770-999-2506"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1120 WELLSTAR WAY STE 201",
            "city": "HOLLY SPRINGS",
            "state": "GA",
            "postal_code": "30114",
            "telephone_number": "770-517-1900",
            "fax_number": "770-999-2506"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2230 Towne Lake Pkwy",
            "address_2": "Building 300, Suite 100",
            "address_purpose": "LOCATION",
            "city": "Woodstock",
            "state": "GA",
            "postal_code": "301895540",
            "country_code": "US",
            "telephone_number": "770-517-1900",
            "fax_number": "770-926-3215",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GOLD",
        "first_name": "SAMUEL",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-21",
        "last_updated": "2019-10-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080I0007X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Clinical & Laboratory Immunology",
            "state": "GA",
            "license": "044468",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "sgold12224@directwellstar.org",
            "affiliation": "N",
            "address_1": "1120 Wellstar Way Ste 201",
            "city": "Holly Springs",
            "state": "GA",
            "country_code": "US",
            "postal_code": "30114",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Embrace Mobility Therapy Services
• Oliver Raymond Evans II, D.C.
• Jillian Ferdinand, DC
• Jazzmin Gastley, MS, LPC, RPT
• Georgia Chiropractic and Massage, PC
• Sherene Good, RN, CDE
• Kelli Hardin, APRN
• Jason Robert Hefner, MD
• Aviva Hilburg, LDO, ABOC, NCLEC
• Philip M Hotchkiss, PA-C

• Pediatrics Physician in Holly Springs, GA
• Providers in Holly Springs, GA by specialty
• Pediatrics Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2019; 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.