Cheryl Susan Sam

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

12894 Issued in GA

Practice address

841 Prudential Dr
Jacksonville, FL 32207-8329

Phone

(404) 862-4654

NPI assigned

May 20, 2025

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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.

• Georgia Emergency Medicine Specialists, PC

  • Emergency Medicine Physician
  • Athens, GA
  • NPI 1316064629
  Medicare reassignment

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

{
    "created_epoch": "1747699200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1747699200000",
    "number": "1659163335",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3110 WELLBROOK DR",
            "city": "LOGANVILLE",
            "state": "GA",
            "postal_code": "300524996",
            "telephone_number": "770-862-8477"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "841 PRUDENTIAL DR",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322078329",
            "telephone_number": "404-862-4654"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SAM",
        "first_name": "CHERYL",
        "middle_name": "SUSAN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-05-20",
        "last_updated": "2025-05-20",
        "certification_date": "2025-05-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "GA",
            "license": "12894",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Salveo Medicine LLC
• Tiffany Ann Salveson, IDC
• Christina Salvia, DC
• Rona Rose Salvilla
• Paul Salzer, ANP-C
• Pooja Sam, DDS
• Sam'S Club Optical
• Sam'S Club Optical
• Sam'S Club Optical
• Srinivas Sama

• Physician Assistant in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2025; 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.