Healthcare Provider Details

I. General information

NPI: 1881029965
Provider Name (Legal Business Name): JONATHAN PAUL SAMAHA PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2013
Last Update Date: 10/31/2022
Certification Date: 10/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 FORDING ISLAND RD STE 100
BLUFFTON SC
29910-5168
US

IV. Provider business mailing address

PO BOX 2330
BLUFFTON SC
29910-2330
US

V. Phone/Fax

Practice location:
  • Phone: 843-837-4400
  • Fax: 843-837-4440
Mailing address:
  • Phone: 843-837-4400
  • Fax: 843-837-4440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: