Provider Demographics
NPI:1497434013
Name:GILLINGHAM, SAMANTHA MICHELLE (DC)
Entity Type:Individual
Prefix:DR
First Name:SAMANTHA
Middle Name:MICHELLE
Last Name:GILLINGHAM
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:189 OAK SPRINGS LN
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:GA
Mailing Address - Zip Code:30132-1045
Mailing Address - Country:US
Mailing Address - Phone:270-505-2435
Mailing Address - Fax:
Practice Address - Street 1:1240 HIGHWAY 54 W STE 503
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-4561
Practice Address - Country:US
Practice Address - Phone:678-667-4660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-12
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIRO11044111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor