1740326438 NPI number — DR. RENEE DONNA MARIA SAMUELS DDS

Table of content: DR. RENEE DONNA MARIA SAMUELS DDS (NPI 1740326438)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740326438 NPI number — DR. RENEE DONNA MARIA SAMUELS DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SAMUELS
Provider First Name:
RENEE
Provider Middle Name:
DONNA MARIA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
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:
1740326438
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/05/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6051 FARMWOOD WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MABLETON
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30126
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-964-0494
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5370 CAMPBELLTON FAIRBURN ROAD
Provider Second Line Business Practice Location Address:
SUITE 130
Provider Business Practice Location Address City Name:
FAIRBURN
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30213
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-964-0494
Provider Business Practice Location Address Fax Number:
770-964-0468
Provider Enumeration Date:
01/29/2007

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: 1223G0001X , with the licence number:  DN012682 , 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)





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