Provider Demographics
NPI:1275332371
Name:BANKS, SAMANTHA (MSN, RN)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:BANKS
Suffix:
Gender:
Credentials:MSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 REGENCY PL
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30016-4621
Mailing Address - Country:US
Mailing Address - Phone:404-979-1257
Mailing Address - Fax:
Practice Address - Street 1:1240 SIGMAN RD NW STE 103
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30012-3934
Practice Address - Country:US
Practice Address - Phone:404-965-0633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-11
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN251148163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse