Provider Demographics
NPI:1306579552
Name:ROWE, RUSHELL SAMANTHA
Entity type:Individual
Prefix:
First Name:RUSHELL
Middle Name:SAMANTHA
Last Name:ROWE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:824 HICKMAN RD APT D37
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30904-7108
Mailing Address - Country:US
Mailing Address - Phone:706-399-4717
Mailing Address - Fax:
Practice Address - Street 1:1537 WALTON WAY
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30904-3764
Practice Address - Country:US
Practice Address - Phone:706-731-1200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-06
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN289436163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse