Provider Demographics
NPI:1356099014
Name:SAMAR HEALTHCARE
Entity type:Organization
Organization Name:SAMAR HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NP
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:W
Authorized Official - Last Name:MURANJA
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC, NP-C
Authorized Official - Phone:770-827-5291
Mailing Address - Street 1:PO BOX 801351
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30101-1215
Mailing Address - Country:US
Mailing Address - Phone:770-827-5291
Mailing Address - Fax:
Practice Address - Street 1:1122 CAMBRIDGE SQ STE D
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30009-1858
Practice Address - Country:US
Practice Address - Phone:678-904-2450
Practice Address - Fax:678-904-2320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-12
Last Update Date:2022-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1407210156OtherNPI