Provider Demographics
NPI:1235883620
Name:DAVIS, SAMANTHA ANN (PA)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:ANN
Last Name:DAVIS
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:2369 STAPLES MILL RD STE 200
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23230-2918
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6602 W BROAD ST STE B
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-1702
Practice Address - Country:US
Practice Address - Phone:804-289-1137
Practice Address - Fax:804-440-3074
Is Sole Proprietor?:No
Enumeration Date:2022-02-05
Last Update Date:2023-08-01
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical