Healthcare Provider Details

I. General information

NPI: 1528434552
Provider Name (Legal Business Name): ANDREA SAMAHA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2015
Last Update Date: 08/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1113 WASHINGTON RD
THOMSON GA
30824-7523
US

IV. Provider business mailing address

3686 WHEELER RD
AUGUSTA GA
30909-6520
US

V. Phone/Fax

Practice location:
  • Phone: 706-595-7825
  • Fax: 706-595-1235
Mailing address:
  • Phone: 706-922-6300
  • Fax: 706-922-6303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN199522
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: