Healthcare Provider Details

I. General information

NPI: 1376415422
Provider Name (Legal Business Name): SAMANTHA BAILEY HOFFMAN MS, RD, NBC-HWC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2025
Last Update Date: 09/18/2025
Certification Date: 09/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 MONTAG CIR NE UNIT 450
ATLANTA GA
30307-5539
US

IV. Provider business mailing address

185 MONTAG CIR NE UNIT 450
ATLANTA GA
30307-5539
US

V. Phone/Fax

Practice location:
  • Phone: 256-736-3193
  • Fax:
Mailing address:
  • Phone: 256-736-3193
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number007651
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: