Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 224P00000X | Prosthetist |
NPI | 1114537313 |
---|---|
Provider Name | Kimberly Melissa Sampson |
First Address | Snellville, GA 30078-0497 |
Second Address | Snellville, GA 30078-6134 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/08/2020 |
Last Update Date | 04/08/2020 |