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General NPI Number Information
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NPI Number | 1225597248
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Entity Type | Individual
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Provider Name | SAMANTHA ALANA GREENSEID DO
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Gender | Female
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Dates
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Enumeration Date | 03/19/2019
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Last Update Date | 03/18/2025
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Provider Practice Location Address
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Address Line | 1365 CLIFTON RD NE BLDG C
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City | ATLANTA
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State | GA
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Zip | 30322-3781
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Country | US
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Telephone | 404-778-3307
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Fax | 404-778-4255
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Provider Business Mailing Address
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Address Line | 943 NW 124TH AVE
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City | CORAL SPRINGS
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State | FL
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Zip | 33071-5082
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Country | US
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Telephone | 954-940-2103
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 103382
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License Number State | GA
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