Individual
SAMANTHA ANN LIDDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
100 A LINDSEY LANE, KINGSLAND, GA 31548-0000
(912) 729-1333
(912) 729-5259
Mailing address
PO BOX 949, ROME, GA 30162-0949
(706) 802-1991
(706) 802-1408
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AL2498
FL
2255A2300X
Athletic Trainer
AT001475
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AL2498
LICENSES
FL
01
—
AT001475
LICENSES
GA
Enumeration date
06/30/2010
Last updated
06/30/2010
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