Healthcare Provider Details

I. General information

NPI: 1336460922
Provider Name (Legal Business Name): JENNIFER SAMPLES HOLL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JENNIFER ELIZABETH SAMPLES MD

II. Dates (important events)

Enumeration Date: 06/17/2010
Last Update Date: 05/14/2025
Certification Date: 05/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5667 PEACHTREE DUNWOODY RD
ATLANTA GA
30342-1725
US

IV. Provider business mailing address

5667 PEACHTREE DUNWOODY RD
ATLANTA GA
30342-1725
US

V. Phone/Fax

Practice location:
  • Phone: 404-252-5669
  • Fax: 404-252-9473
Mailing address:
  • Phone: 404-252-5669
  • Fax: 404-252-9473

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License NumberME162888
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number103860
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number2018-01719
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: