Provider Demographics
NPI:1043406069
Name:SAMUELS, ANGELLA (DNP)
Entity Type:Individual
Prefix:DR
First Name:ANGELLA
Middle Name:
Last Name:SAMUELS
Suffix:
Gender:F
Credentials:DNP
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Mailing Address - Street 1:2795 MAIN ST W BLDG 21
Mailing Address - Street 2:NEW HORIZONS FAMILY CLINIC
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-3164
Mailing Address - Country:US
Mailing Address - Phone:770-248-1637
Mailing Address - Fax:770-248-1638
Practice Address - Street 1:2795 MAIN ST W BLDG 21
Practice Address - Street 2:NEW HORIZONS FAMILY CLINIC
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-3164
Practice Address - Country:US
Practice Address - Phone:770-248-1637
Practice Address - Fax:770-248-1638
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-24
Last Update Date:2023-03-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GARN133706363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA844105153AMedicaid
GAMS1721530OtherDEA
GA844105153AMedicaid