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NPI Code Detail

MEDICARE: MS. SAMANTHA S GREENE PAC

MEDICARE: MS. SAMANTHA S GREENE PAC
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
1363A00000XPhysician AssistantPA9101566FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1972544997
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. SAMANTHA S GREENE PAC
Provider Business Mailing Address
First Line : PO BOX 102222
Second Line :
City : ATLANTA
State : GA
Zip : 30368-2222
Country : US
Telephone Number : 239-274-8200
Fax Number :
Provider Business Practice Location Address
First Line : 6420 W NEWBERRY RD STE 100
Second Line :
City : GAINESVILLE
State : FL
Zip : 32605-6622
Country : US
Telephone Number : 352-332-3900
Fax Number : 352-332-5009
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/09/2006
Last Update Date : 02/03/2026

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Directions to “ MS. SAMANTHA S GREENE PAC” Practice Location

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