Healthcare Provider Details

I. General information

NPI: 1861117129
Provider Name (Legal Business Name): SAMANTHA SOTO APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2022
Last Update Date: 07/29/2024
Certification Date: 07/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6413 WATERS AVE STE 102
SAVANNAH GA
31406-2711
US

IV. Provider business mailing address

128 NANDINA WAY
POOLER GA
31322-4074
US

V. Phone/Fax

Practice location:
  • Phone: 912-349-6624
  • Fax: 912-352-4728
Mailing address:
  • Phone: 239-784-7952
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberRN315630
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN315630
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: