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General NPI Number Information
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NPI Number | 1508359803
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Entity Type | Individual
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Provider Name | SAMIYA JABIR
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Gender | Female
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Dates
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Enumeration Date | 06/11/2018
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Last Update Date | 01/24/2025
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Provider Practice Location Address
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Address Line | 2133 LAVISTA EXEC PARK DR
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City | TUCKER
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State | GA
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Zip | 30084-5422
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Country | US
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Telephone | 770-939-6760
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Fax |
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Provider Business Mailing Address
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Address Line | 2706 SKYLAND DR NE
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City | BROOKHAVEN
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State | GA
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Zip | 30319-3646
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Country | US
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Telephone | 724-840-6655
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | DS042046
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | DN123051
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License Number State | GA
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