NPIMap

Individual provider Active NPI

Samuel Davis Mintlow, M.D.

  • Internal Medicine Physician
  • Conyers, GA
National Provider Identifier
1982845665
Registry record updated Mar 10, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
028824 Issued in GA
Practice address
3241 Lindas Cir SE
Conyers, GA 30013-2238
Phone
(404) 217-9545
NPI assigned
Mar 10, 2009
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 10, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 028824 GA Primary

Addresses

Primary practice location

3241 Lindas Cir SE
Conyers, GA 30013-2238

Mailing address

3241 Lindas Cir SE
Conyers, GA 30013-2238
Phone (404) 217-9545

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
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
028824GAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Progressive Pain Centers Past Accepting new patients
Total Health Medical Center Corporation Past Accepting new patients

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1236643200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1236643200000",
    "number": "1982845665",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3241 LINDAS CIR SE",
            "city": "CONYERS",
            "state": "GA",
            "postal_code": "300132238",
            "telephone_number": "404-217-9545"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3241 LINDAS CIR SE",
            "city": "CONYERS",
            "state": "GA",
            "postal_code": "300132238",
            "telephone_number": "404-217-9545"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MINTLOW",
        "first_name": "SAMUEL",
        "middle_name": "DAVIS",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-03-10",
        "last_updated": "2009-03-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "GA",
            "license": "028824",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Conyers, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2009; 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.