Healthcare Provider Details

I. General information

NPI: 1487433462
Provider Name (Legal Business Name): DANIELLE G SAMSURY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2023
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 SELIG CIR
ATHENS GA
30602-1501
US

IV. Provider business mailing address

1029 REGENCY DR
ACWORTH GA
30102-1364
US

V. Phone/Fax

Practice location:
  • Phone: 706-542-1231
  • Fax:
Mailing address:
  • Phone: 404-444-2994
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT004661
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: