Healthcare Provider Details

I. General information

NPI: 1184561854
Provider Name (Legal Business Name): SHARMILA SAMUEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2026
Last Update Date: 04/30/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

341 PONCE DE LEON AVE NE
ATLANTA GA
30308-2012
US

IV. Provider business mailing address

100 ORCHARD PARK DR UNIT 26416
GREENVILLE SC
29616-5060
US

V. Phone/Fax

Practice location:
  • Phone: 404-616-2440
  • Fax:
Mailing address:
  • Phone: 864-704-2572
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: