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General NPI Number Information
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NPI Number | 1871208033
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Entity Type | Individual
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Provider Name | SAMANTHA SHEPHERD NP
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Gender | Female
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Dates
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Enumeration Date | 01/20/2023
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Last Update Date | 01/20/2023
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Provider Practice Location Address
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Address Line | 10800 ALPHARETTA HWY STE 240
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City | ROSWELL
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State | GA
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Zip | 30076-5689
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Country | US
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Telephone | 470-532-7802
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Fax |
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Provider Business Mailing Address
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Address Line | 510 CREEK VIEW LN
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City | ROSWELL
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State | GA
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Zip | 30075-4994
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Country | US
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Telephone | 470-532-7802
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN213266
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License Number State | GA
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