Provider Demographics
NPI:1598213944
Name:AKINNUBI, SAMANTHA ELAINE
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:ELAINE
Last Name:AKINNUBI
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 1:1737 PINEKNOLL LN
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31707-3778
Mailing Address - Country:US
Mailing Address - Phone:229-603-1968
Mailing Address - Fax:
Practice Address - Street 1:1737 PINEKNOLL LN
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31707-3778
Practice Address - Country:US
Practice Address - Phone:229-603-1968
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-14
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator