MEDICARE: SAMANTHA NABORS GILLIATT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician		NC

General Provider Information

NPI Number	:	1043144546
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA NABORS GILLIATT

Provider Business Mailing Address
First Line	:	7 OAK BRANCH DR STE E
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27407-2392
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7 OAK BRANCH DR STE E
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27407-2392
Country	:	US
Telephone Number	:	888-392-8642
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/10/2026
Last Update Date	:	06/10/2026

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