Provider Demographics
NPI:1497479570
Name:WILLIAMS, SAMANTHA IRENE
Entity Type:Individual
Prefix:MS
First Name:SAMANTHA
Middle Name:IRENE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 GLENRIDGE POINT PKWY UNIT 1511
Mailing Address - Street 2:
Mailing Address - City:SANDY SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1483
Mailing Address - Country:US
Mailing Address - Phone:914-771-0698
Mailing Address - Fax:
Practice Address - Street 1:1800 HOWELL MILL RD NW STE 600
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30318-0920
Practice Address - Country:US
Practice Address - Phone:404-351-9512
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-03
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA12108363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant