Healthcare Provider Details

I. General information

NPI: 1043755853
Provider Name (Legal Business Name): SAMANTHA WISNER VALENTINI RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2017
Last Update Date: 05/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2551 WILSON WOODS DR
DECATUR GA
30033
US

IV. Provider business mailing address

108 AMELIA FOREST LN
COLUMBIA SC
29209-1759
US

V. Phone/Fax

Practice location:
  • Phone: 770-757-0131
  • Fax:
Mailing address:
  • Phone: 770-757-0131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN213713
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN213713
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: