Healthcare Provider Details

I. General information

NPI: 1871497198
Provider Name (Legal Business Name): SAMANTHA PEART
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 09/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

178 STARGRASS WAY
GRAYSON GA
30017-4301
US

IV. Provider business mailing address

178 STARGRASS WAY
GRAYSON GA
30017-4301
US

V. Phone/Fax

Practice location:
  • Phone: 205-209-0912
  • Fax:
Mailing address:
  • Phone: 205-209-0912
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN319621
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: