Provider Demographics
NPI:1679014781
Name:CALL, SAMANTHA TARA (PA-C)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:TARA
Last Name:CALL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:704-638-8631
Mailing Address - Fax:704-638-8639
Practice Address - Street 1:1910 JAKE ALEXANDER BLVD W STE 201
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28147
Practice Address - Country:US
Practice Address - Phone:704-638-8631
Practice Address - Fax:704-638-8639
Is Sole Proprietor?:No
Enumeration Date:2017-03-09
Last Update Date:2018-10-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC363A00000X
NC0010-07183363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant