1598165938 NPI number — SAMANTHA ANN MURRILL WILLIAMS NP

Table of content: (NPI 1376096321)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598165938 NPI number — SAMANTHA ANN MURRILL WILLIAMS NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MURRILL WILLIAMS
Provider First Name:
SAMANTHA
Provider Middle Name:
ANN
Provider Name Prefix Text:
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:
MURRILL
Provider Other First Name:
SAMANTHA
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
NP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1598165938
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/05/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
550 WHITE OAK ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ASHEBORO
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27203-4710
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-625-1360
Provider Business Mailing Address Fax Number:
336-625-1889

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
197 NC HIGHWAY 42 N STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ASHEBORO
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27203
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-625-2560
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/03/2014

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: 363L00000X , with the licence number:  5007121 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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