Healthcare Provider Details

I. General information

NPI: 1144882044
Provider Name (Legal Business Name): RADHA SAMTANI NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2019
Last Update Date: 10/12/2022
Certification Date: 10/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 HOWELL MILL RD NW STE 300
ATLANTA GA
30318-0918
US

IV. Provider business mailing address

1364 CLIFTON RD NE
ATLANTA GA
30322-1064
US

V. Phone/Fax

Practice location:
  • Phone: 404-425-1380
  • Fax:
Mailing address:
  • Phone: 404-712-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN289918
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberRN289918
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: