Provider Demographics
NPI:1225597248
Name:GREENSEID, SAMANTHA ALANA (DO)
Entity type:Individual
Prefix:DR
First Name:SAMANTHA
Middle Name:ALANA
Last Name:GREENSEID
Suffix:
Gender:
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:943 NW 124TH AVE
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33071-5082
Mailing Address - Country:US
Mailing Address - Phone:954-940-2103
Mailing Address - Fax:
Practice Address - Street 1:1365 CLIFTON RD NE BLDG C
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322-3781
Practice Address - Country:US
Practice Address - Phone:404-778-3307
Practice Address - Fax:404-778-4255
Is Sole Proprietor?:No
Enumeration Date:2019-03-19
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
GA103382208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program