MEDICARE: DR. ANGELLA SAMUELS DNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	RN133706	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043406069
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANGELLA SAMUELS DNP

Provider Business Mailing Address
First Line	:	2795 MAIN ST W BLDG 21
Second Line	:	NEW HORIZONS FAMILY CLINIC
City	:	SNELLVILLE
State	:	GA
Zip	:	30078-3164
Country	:	US
Telephone Number	:	770-248-1637
Fax Number	:	770-248-1638

Provider Business Practice Location Address
First Line	:	2795 MAIN ST W BLDG 21
Second Line	:	NEW HORIZONS FAMILY CLINIC
City	:	SNELLVILLE
State	:	GA
Zip	:	30078-3164
Country	:	US
Telephone Number	:	770-248-1637
Fax Number	:	770-248-1638

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/24/2007
Last Update Date	:	03/07/2023

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