Active NPI
Ajely Samuel
- Pharmacist
- Lawrenceville, GA
National Provider Identifier
1902407828
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 023800
- Practice address
- 630 Collins Hill Rd
Lawrenceville, GA 30046-4453 - Phone
- (770) 995-5212
- NPI assigned
- Nov 6, 2020
- Last updated
- Nov 6, 2020
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 023800 | GA | Primary |
Addresses
Primary practice location
630 Collins Hill Rd
Lawrenceville, GA 30046-4453
Mailing address
3471 Jim Moore Rd
Dacula, GA 30019-1151
Phone (919) 264-3365
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 023800 | GA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1604620800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1604620800000",
"number": "1902407828",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3471 JIM MOORE RD",
"city": "DACULA",
"state": "GA",
"postal_code": "300191151",
"telephone_number": "919-264-3365"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "630 COLLINS HILL RD",
"city": "LAWRENCEVILLE",
"state": "GA",
"postal_code": "300464453",
"telephone_number": "770-995-5212"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SAMUEL",
"first_name": "AJELY",
"name_prefix": "Mrs.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-11-06",
"last_updated": "2020-11-06",
"certification_date": "2020-11-06",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "GA",
"license": "023800",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lawrenceville, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.