MEDICARE: PATRICE L SAMM

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	172M00000X	Mechanotherapist

General Provider Information

NPI Number	:	1912579772
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICE L SAMM

Provider Business Mailing Address
First Line	:	5486 MARTIN CT
Second Line	:
City	:	ELLENWOOD
State	:	GA
Zip	:	30294-4602
Country	:	US
Telephone Number	:	132-324-1264
Fax Number	:

Provider Business Practice Location Address
First Line	:	236 STOCKBRIDGE RD # B-1
Second Line	:
City	:	JONESBORO
State	:	GA
Zip	:	30236-3629
Country	:	US
Telephone Number	:	323-241-2646
Fax Number	:

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

Provider Enumeration Date	:	07/12/2021
Last Update Date	:	07/12/2021

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Directions to “ PATRICE L SAMM ” Practice Location

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