Provider Demographics
NPI:1992335863
Name:DAVIS, SAMANTHA LYNN (NP)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:LYNN
Last Name:DAVIS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:LYNN
Other - Last Name:CLAYBROOK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP, RN
Mailing Address - Street 1:6714 SAND RD
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31410-2308
Mailing Address - Country:US
Mailing Address - Phone:229-291-1616
Mailing Address - Fax:
Practice Address - Street 1:6301 ABERCORN ST
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-5701
Practice Address - Country:US
Practice Address - Phone:912-352-8700
Practice Address - Fax:912-650-6805
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-20
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC23608363LF0000X
GARN260006363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily