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General NPI Number Information
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NPI Number | 1063397370
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Entity Type | Individual
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Provider Name | SAMANTHA DENISE BANKS CSFA
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Gender | Female
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Dates
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Enumeration Date | 08/06/2025
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Last Update Date | 08/06/2025
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Provider Practice Location Address
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Address Line | 1267 GA-54 #200
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City | FAYETTEVILLE
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State | GA
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Zip | 30214
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Country | US
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Telephone | 770-460-1900
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Fax |
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Provider Business Mailing Address
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Address Line | 1267 BRIARCLIFF RD
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City | MACON
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State | GA
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Zip | 31211-1705
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Country | US
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Telephone | 386-249-2458
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 246ZC0007X
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Taxonomy Name | Surgical Assistant
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License Number | 183796
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License Number State | GA
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