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General NPI Number Information
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NPI Number | 1255364774
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Entity Type | Individual
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Provider Name | KATHY ANN SAMUELS O.D.
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Gender | Female
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Dates
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Enumeration Date | 07/08/2006
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Last Update Date | 08/24/2012
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Provider Practice Location Address
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Address Line | 1201 N PEACHTREE PKWY
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City | PEACHTREE CITY
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State | GA
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Zip | 30269-1743
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Country | US
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Telephone | 404-861-7253
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Fax | 404-264-9459
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Provider Business Mailing Address
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Address Line | 1201 N PEACHTREE PKWY
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City | PEACHTREE CITY
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State | GA
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Zip | 30269-1743
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Country | US
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Telephone | 404-861-7253
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Fax | 404-264-9549
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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 | 152W00000X
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Taxonomy Name | Optometrist
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License Number | GA1408
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License Number State | GA
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