Healthcare Provider Details

I. General information

NPI: 1962143735
Provider Name (Legal Business Name): SAMAH HISAMUDDIN SYED DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2022
Last Update Date: 09/24/2025
Certification Date: 09/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

833 CAMPBELL HILL ST NW STE 250
MARIETTA GA
30060-1162
US

IV. Provider business mailing address

833 CAMPBELL HILL ST NW
MARIETTA GA
30060-1134
US

V. Phone/Fax

Practice location:
  • Phone: 470-956-2020
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number102941
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: