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General NPI Number Information
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NPI Number | 1326591397
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Entity Type | Individual
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Provider Name | SHABNAM SAMSUDDIN CRNA
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Gender | Female
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Dates
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Enumeration Date | 07/26/2016
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Last Update Date | 10/08/2025
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Provider Practice Location Address
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Address Line | 1100 JOHNSON FERRY RD BLDG 2, UNIT 593
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City | ATLANTA
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State | GA
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Zip | 30342-1733
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Country | US
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Telephone | 404-255-9096
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Fax |
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Provider Business Mailing Address
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Address Line | 845 CONSTELLATION DR
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City | DECATUR
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State | GA
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Zip | 30033-2814
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Country | US
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Telephone | 404-642-5728
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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 | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | RN226046
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License Number State | GA
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