Provider Demographics
NPI:1588952063
Name:MANDERSON, SAMANTHA DAHLIA (MD)
Entity type:Individual
Prefix:DR
First Name:SAMANTHA
Middle Name:DAHLIA
Last Name:MANDERSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 E 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:CORDELE
Mailing Address - State:GA
Mailing Address - Zip Code:31015
Mailing Address - Country:US
Mailing Address - Phone:229-276-3038
Mailing Address - Fax:229-276-3631
Practice Address - Street 1:412 E 4TH AVE
Practice Address - Street 2:
Practice Address - City:CORDELE
Practice Address - State:GA
Practice Address - Zip Code:31015
Practice Address - Country:US
Practice Address - Phone:229-276-3038
Practice Address - Fax:229-276-3631
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-18
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA65938207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology