MR. SAMUEL E WORTHINGTON IV (NPI# 1023022290) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1023022290 |
| Entity Type | Individual |
| Full Name | MR. SAMUEL E WORTHINGTON IV |
| Credential | D.M.D. |
| Practice Address |
2804 N Oak St Suite B Valdosta GA 31602-1716 |
| Practice Telephone | 2292420063 |
| Practice Fax Number | 2292428860 |
| Mailing Telephone | 2292420063 |
| Mailing Fax Number | 2292428860 |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| X | 1223G0001X |
Dentist Specialization: General Practice |
D012344 | GA | Dental Providers |
| X | 284300000X | Special Hospital | D012344 | GA | Hospitals |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| GA | 00919949A | 05 | |
| GA | UNITED CONCORDIA | 1319905 | 01 |
| Street Address |
2804 N OAK ST SUITE B |
| City | VALDOSTA |
| State | GA |
| Zip Code | 31602-1716 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790147908 | Richard Wa Rickman LLC | Preferred Provider Organization | 2804 N Oak St, Suite A, Valdosta, GA 31602-5914 | 2016-03-26 |
| 1083017784 | Heather Hyers | Nurse Practitioner | 2804 N Oak St, Valdosta, GA 31602-5914 | 2014-10-08 |
| 1285063842 | Sara Lewis | Clinic/Center | 2804 N Oak St, Ste C, Valdosta, GA 31602-5914 | 2013-11-04 |
| 1508293465 | Destiny Medical Services, Inc | Physical Medicine & Rehabilitation | 2804 N Oak St, Valdosta, GA 31602-5914 | 2013-10-08 |
| 1063521250 | Care Medical Center | Exclusive Provider Organization | 2804 N Oak St, Suite C, Valdosta, GA 31602-1716 | 2006-08-30 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477198117 | Amber Michele Baugh | Behavior Technician | 2236 Bemiss Road, Valdosta, GA 31602 | 2019-11-15 |
| 1528611365 | Nishaben T. Patel | Nurse Practitioner | 3120 North Oak Street Extension, Suite B, Valdosta, GA 31602 | 2019-07-22 |
| 1427615871 | Blair Elizabeth Tomlinson | Nurse Practitioner | 2124 Lakeshore Drive, Valdosta, GA 31602 | 2019-05-21 |
| 1346704152 | Mildred Itaska Borowski | Counselor | 3790 North Highway 41, Suite A, Valdosta, GA 31602 | 2019-01-25 |
| 1962991703 | Southern Healthcare Alliance, LLC | Physical Medicine & Rehabilitation | 101-f W. Northside Drive, Valdosta, GA 31602 | 2018-05-08 |
| 1336636646 | Kaitlyn Thrift | Behavioral Analyst | 2225 Bemiss Road Suite D, Valdosta, GA 31602 | 2018-04-23 |
| 1407379845 | Lindsey Marie Richardson | Dentist | 103 W. Cranford Ave, Valdosta, GA 31602 | 2017-07-18 |
| 1962922427 | Taylor Nicole Fiveash | Nurse Practitioner | 101 W Northisde Dr, Bldg G, Valdosta, GA 31602 | 2017-06-26 |
| 1720520646 | Southern Sleepers Anesthesia LLC | Nurse Anesthetist, Certified Registered | 4120-b N. Valdosta Road, Valdosta, GA 31602 | 2016-11-09 |
| 1134670557 | Cataract and Laser Surgery Center of South Georgia, P.C. | Clinic/Center | 4120-b N. Valdosta Rd., Valdosta, GA 31602 | 2016-10-20 |
| Find all providers in zip 31602 | ||||
| Taxonomy Code | 1223G0001X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | General Practice |
| A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. |
| Notes: Source: Academy of General Dentistry |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407379845 | Lindsey Marie Richardson | Dentist | 103 W. Cranford Ave, Valdosta, GA 31602 | 2017-07-18 |
| 1780099507 | Ronnie Neil Jenkins Jr. | Dentist | 282 Norman Dr, Suite D, Valdosta, GA 31601-5487 | 2014-07-01 |
| 1720316250 | Nadezhda Dmitrievna Pokrovskaya | Dentist | 2722 N Oak St, Valdosta, GA 31602-1770 | 2009-11-20 |
| 1104152404 | Advanced Dental Care | Dentist | 3211 Wildwood Plantation Dr, Valdosta, GA 31605-1042 | 2009-10-22 |
| 1336310317 | Worthington Family Dentistry, P.C. | Dentist | 2804 N Oak St Ste B, Valdosta, GA 31602-5913 | 2008-03-18 |
| 1881807881 | Patrick W. Powell | Dentist | 3022 N Patterson St, Valdosta, GA 31602-1711 | 2007-05-07 |
| 1821121781 | Glenn T Swindle | Dentist | 114 W Moore St, Valdosta, GA 31602-2917 | 2007-03-13 |
| 1831236181 | William Ashley Moorman | Dentist | Advanced Dental Care, 3211 Wildwood Plantation Drive, Valdosta, GA 31605 | 2007-01-30 |
| 1184761447 | William S Moorman | Dentist | 3211 Wildwood Plantation Drive, Advanced Dental Care, Valdosta, GA 31605 | 2007-01-30 |
| 1295883957 | Stanley Bernard Marable | Dentist | 308 Janet St, Valdosta, GA 31602-2602 | 2007-01-08 |
| Find all providers in VALDOSTA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.