Individual
KATHRYN B SAMPLES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.-C.
Contact information
Practice address
157 CLINIC AVE, SUITE 302, CARROLLTON, GA 30117-4413
(770) 834-3336
(770) 832-2136
Mailing address
119 AMBULANCE DR, SUITE 202, CARROLLTON, GA 30117-3857
(770) 838-8710
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
003055
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100000202A
—
GA
Enumeration date
11/30/2005
Last updated
01/27/2016
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