MEDICARE: SAMANTHA MARIE BARRACLOUGH PA

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	13521	GA

General Provider Information

NPI Number	:	1780232819
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA MARIE BARRACLOUGH PA

Provider Business Mailing Address
First Line	:	104 WOODMONT BLVD STE 500
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37205-2245
Country	:	US
Telephone Number	:	888-802-9885
Fax Number	:

Provider Business Practice Location Address
First Line	:	1810 STADIUM DR STE 240
Second Line	:
City	:	PHENIX CITY
State	:	AL
Zip	:	36867-3179
Country	:	US
Telephone Number	:	334-297-4883
Fax Number	:

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

Provider Enumeration Date	:	09/02/2019
Last Update Date	:	02/03/2026

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