Frederick, Samantha F

Frederick, Samantha F is an individual health care provider with primary practice located at 228 Riverstone Dr , Canton GA 30114-5256. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner, which is considered as her primary health care specialty. Frederick, Samantha F can be contacted via phone (770) 479-1870.

Contact Information

Primary practice address
228 Riverstone Dr Canton GA 30114-5256
Phone: (770) 479-1870
Fax: (770) 479-9705
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner 363L00000X RN203567 Georgia

Profile Details

NPI number 1124614631
LBN Legal business name Frederick, Samantha F
Credentials NP-C
Entity Individual
Sole proprietor 1 No
Enumeration date Dec 18th, 2020
Last updated Sep 30th, 2021 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1124614631 NPPES
Georgia Other G24488A MEDICARE PTAN
Georgia MEDICAID 003245264A MEDICARE PTAN
Georgia MEDICAID 003245264B MEDICARE PTAN

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