Provider Demographics
NPI:1679974463
Name:SMITH, SAMANTHA BRITTANY (AUD)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:BRITTANY
Last Name:SMITH
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:B
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:215 RIVERSTONE DR
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114-5256
Mailing Address - Country:US
Mailing Address - Phone:770-345-6600
Mailing Address - Fax:770-345-6611
Practice Address - Street 1:5673 PEACHTREE DUNWOODY RD STE 150
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1771
Practice Address - Country:US
Practice Address - Phone:404-297-4230
Practice Address - Fax:404-252-7255
Is Sole Proprietor?:No
Enumeration Date:2014-09-11
Last Update Date:2019-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAUD003981231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist