Provider Demographics
NPI:1508133216
Name:SMITH, SAMANTHA STANFIELD (PT, MHS)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:STANFIELD
Last Name:SMITH
Suffix:
Gender:F
Credentials:PT, MHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3355 SAXONY GLN
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-4797
Mailing Address - Country:US
Mailing Address - Phone:864-979-8826
Mailing Address - Fax:
Practice Address - Street 1:3355 SAXONY GLN
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30066-4797
Practice Address - Country:US
Practice Address - Phone:864-979-8826
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-23
Last Update Date:2016-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1204203225100000X
GA012235225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist