Healthcare Provider Details

I. General information

NPI: 1730356379
Provider Name (Legal Business Name): AMANDA SAMPEY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2008
Last Update Date: 05/09/2020
Certification Date: 05/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1205 MCCONNELL DR
DECATUR GA
30033-3501
US

IV. Provider business mailing address

5915 WILD TIMBER RD
SUGAR HILL GA
30518-5688
US

V. Phone/Fax

Practice location:
  • Phone: 504-460-1395
  • Fax:
Mailing address:
  • Phone: 504-460-1395
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number68552
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License Number68552
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: