Provider Demographics
NPI:1831920636
Name:DAVIS, SAMANTHA SHANTA (MA,CNA,CMA)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:SHANTA
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MA,CNA,CMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 E 38TH ST
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31401-9218
Mailing Address - Country:US
Mailing Address - Phone:912-656-0499
Mailing Address - Fax:
Practice Address - Street 1:610 E 38TH ST
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31401-9218
Practice Address - Country:US
Practice Address - Phone:912-656-0499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-12
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACN00141773413747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant