Healthcare Provider Details

I. General information

NPI: 1316589245
Provider Name (Legal Business Name): SAMANTHA FRUGE CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2019
Last Update Date: 10/25/2021
Certification Date: 10/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 BYRD WAY
WARNER ROBINS GA
31088-8937
US

IV. Provider business mailing address

130 BYRD WAY
WARNER ROBINS GA
31088-8937
US

V. Phone/Fax

Practice location:
  • Phone: 478-922-9136
  • Fax: 478-923-6846
Mailing address:
  • Phone: 478-922-9136
  • Fax: 478-923-6846

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberRN216743
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: