Provider Demographics
NPI:1992354443
Name:WILKINSON, SAMANTHA ANN (PC-PNP)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:ANN
Last Name:WILKINSON
Suffix:
Gender:F
Credentials:PC-PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:237 LANDING WAY
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HILL
Mailing Address - State:GA
Mailing Address - Zip Code:31324-4198
Mailing Address - Country:US
Mailing Address - Phone:912-334-0628
Mailing Address - Fax:
Practice Address - Street 1:10055 FORD AVE STE 4A
Practice Address - Street 2:
Practice Address - City:RICHMOND HILL
Practice Address - State:GA
Practice Address - Zip Code:31324-3974
Practice Address - Country:US
Practice Address - Phone:912-527-5352
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-07
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN213158208000000X
GARN213158NP363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No208000000XAllopathic & Osteopathic PhysiciansPediatrics