Individual
MS. SAMANTHA F FREDERICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
228 RIVERSTONE DR, CANTON, GA 30114-5256
(770) 479-1870
(770) 479-9705
Mailing address
1835 SAVOY DR STE 300, ATLANTA, GA 30341-1071
(678) 288-9555
(770) 479-1870
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
RN203567
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003245264A
—
GA
05
—
003245264B
—
GA
01
—
G24488A
MEDICARE PTAN
GA
Enumeration date
12/18/2020
Last updated
09/30/2021
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