1508870460 NPI number — MRS. SAMANTHA R MEEKS NP

Table of content: MRS. SAMANTHA R MEEKS NP (NPI 1508870460)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508870460 NPI number — MRS. SAMANTHA R MEEKS NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MEEKS
Provider First Name:
SAMANTHA
Provider Middle Name:
R
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
NP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1508870460
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/25/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
17 PROFESSIONAL DR STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRUNSWICK
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31520-3784
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
912-574-5819
Provider Business Mailing Address Fax Number:
556-088-6558

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3300 4TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRUNSWICK
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31520-3779
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
912-466-5870
Provider Business Practice Location Address Fax Number:
912-466-5883
Provider Enumeration Date:
07/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LA2200X , with the licence number:  71000462 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: RN235429 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 200429290 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 20250I7380 . This is a "MEDICARE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 003143270A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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