Healthcare Provider Details

I. General information

NPI: 1073441572
Provider Name (Legal Business Name): SAMANTHA BAXTER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3025 SHRINE RD STE 390
BRUNSWICK GA
31520-4786
US

IV. Provider business mailing address

3025 SHRINE RD STE 390
BRUNSWICK GA
31520-4786
US

V. Phone/Fax

Practice location:
  • Phone: 912-466-7340
  • Fax: 912-466-7358
Mailing address:
  • Phone: 912-466-7340
  • Fax: 912-466-7358

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: