Provider Demographics
NPI:1508870460
Name:MEEKS, SAMANTHA R (NP)
Entity Type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:R
Last Name:MEEKS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:17 PROFESSIONAL DR STE 100
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31520-3784
Mailing Address - Country:US
Mailing Address - Phone:912-574-5819
Mailing Address - Fax:556-088-6558
Practice Address - Street 1:3300 4TH ST
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520-3779
Practice Address - Country:US
Practice Address - Phone:912-466-5870
Practice Address - Fax:912-466-5883
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2019-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71000462363LA2200X
GARN235429363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200429290Medicaid
GA20250I7380OtherMEDICARE
GA003143270AMedicaid