MEDICARE: SAMANTHA MCGILL

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	363LF0000X	Family Nurse Practitioner	RN253108	GA

General Provider Information

NPI Number	:	1467990903
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA MCGILL

Provider Business Mailing Address
First Line	:	1717 MAIN ST STE 5850
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75201-7317
Country	:	US
Telephone Number	:	972-449-0540
Fax Number	:

Provider Business Practice Location Address
First Line	:	1634 CLIFTON RD NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30322-6707
Country	:	US
Telephone Number	:	404-712-2000
Fax Number	:

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

Provider Enumeration Date	:	02/04/2017
Last Update Date	:	05/31/2023

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