MEDICARE: SAMANTHA NICOLE WERKHEISER PA-C

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	363A00000X	Physician Assistant	11029	GA
2	208800000X	Urology Physician	0000000	GA

General Provider Information

NPI Number	:	1437893278
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA NICOLE WERKHEISER PA-C

Provider Business Mailing Address
First Line	:	1930 BRANNAN RD
Second Line	:
City	:	MCDONOUGH
State	:	GA
Zip	:	30253-4310
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4298 ATLANTA RD SE STE 300
Second Line	:
City	:	SMYRNA
State	:	GA
Zip	:	30080-6433
Country	:	US
Telephone Number	:	770-429-9100
Fax Number	:	770-429-1391

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

Provider Enumeration Date	:	04/27/2022
Last Update Date	:	02/03/2026

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