Provider Demographics
NPI:1285289082
Name:GROVES, SAMANTHA GREER (MED, CCC-SLP)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:GREER
Last Name:GROVES
Suffix:
Gender:F
Credentials:MED, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:541 ETHRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:HADDOCK
Mailing Address - State:GA
Mailing Address - Zip Code:31033-2386
Mailing Address - Country:US
Mailing Address - Phone:478-320-8879
Mailing Address - Fax:
Practice Address - Street 1:541 ETHRIDGE RD
Practice Address - Street 2:
Practice Address - City:HADDOCK
Practice Address - State:GA
Practice Address - Zip Code:31033-2386
Practice Address - Country:US
Practice Address - Phone:478-320-8879
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-08
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP007056235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist