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General NPI Number Information
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NPI Number | 1093602096
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Entity Type | Individual
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Provider Name | SAMANTHA SMITH PA-C
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Gender | Female
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Dates
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Enumeration Date | 06/23/2025
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Last Update Date | 09/05/2025
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Provider Practice Location Address
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Address Line | 1450 S JOHNSON FERRY RD
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City | ATLANTA
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State | GA
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Zip | 30319-4324
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Country | US
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Telephone | 404-800-4280
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Fax |
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Provider Business Mailing Address
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Address Line | 1551 JANMAR RD
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City | SNELLVILLE
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State | GA
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Zip | 30078-5606
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Country | US
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Telephone | 678-344-8900
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Fax | 678-691-0506
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 13198
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License Number State | GA
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