NELLIE IDARA SAMUEL (NPI# 1821344557) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1821344557 |
| Entity Type | Individual |
| Full Name | NELLIE IDARA SAMUEL |
| Credential | MSN, APRN,PMHNP-BC |
| Practice Address |
2400 Northside Xing Macon GA 31210-2252 |
| Mailing Address |
273 Providence Blvd Macon GA 31210-7565 |
| Practice Telephone | 8657658225 |
| Mailing Telephone | 8657658225 |
| Enumeration Date | 2012-07-31 |
| Last Update Date | 2018-02-01 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 163WP0807X |
Registered Nurse Specialization: Psych/Mental Health, Child & Adolescent |
RN225022 | GA | Nursing Service Providers |
| N | 163WP0808X |
Registered Nurse Specialization: Psych/Mental Health |
RN225022 | GA | Nursing Service Providers |
| N | 163WP0809X |
Registered Nurse Specialization: Psych/Mental Health, Adult |
RN225022 | GA | Nursing Service Providers |
| Y | 363LP0808X |
Nurse Practitioner Specialization: Psych/Mental Health |
RN225022 | GA | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363LP0808X |
Nurse Practitioner Specialization: Psych/Mental Health |
AP10318 | AZ | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
2400 NORTHSIDE XING |
| City | MACON |
| State | GA |
| Zip Code | 31210-2252 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033743455 | Dana Elizabeth Toth | Nurse Practitioner | 5300 Bowman Rd, Macon, GA 31210 | 2020-02-25 |
| 1871124735 | Jessica Bello | Nurse Practitioner | 5300 Bowman Road, Macon, GA 31210 | 2020-01-30 |
| 1225505787 | Rebekah Hollinshead | Occupational Therapist | Therapy Specialists of Georgia, 4116 Arkwright Road, Macon, GA 31210 | 2018-11-01 |
| 1346744943 | Ace Medical Transport LLC. | Ambulance | 728 Gay Dr, Macon, GA 31210 | 2018-03-20 |
| 1972965226 | Omar Faruk Ahmad | Family Medicine | 3400 Riverside Drvie, Macon, GA 31210 | 2016-03-25 |
| 1083074868 | Macon Dentist Office, PC | Dentist | 206 Tom Hill Sr Blvd, Suite 106, Macon, GA 31210 | 2016-03-07 |
| 1992176952 | Kerisia Wasztyl | Marriage & Family Therapist | 4691 Pine Valley Dr, Macon, GA 31210 | 2015-10-15 |
| 1073905444 | Eunice Malave De Leon | Social Worker | 174 Spring St, Macon, GA 31210 | 2015-02-23 |
| 1396141545 | Axis Surgery Center LLC | Clinic/Center | 230 Sheraton Blvd, Ste B, Macon, GA 31210 | 2014-11-17 |
| 1073914115 | Monique Rechelle Delay Moore | Community/Behavioral Health | 646 Millrun Court, Macon, GA 31210 | 2014-09-09 |
| Find all providers in zip 31210 | ||||
| Taxonomy Code | 363LP0808X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Psych/Mental Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346749926 | Hayley Edmonston | Nurse Practitioner | 2994 Woodhaven Cir, Macon, GA 31204-1241 | 2018-02-08 |
| 1740683309 | Psychiatric Np Services | Nurse Practitioner | 5228 Brandywine Dr, Macon, GA 31210-2902 | 2014-09-26 |
| 1356755128 | Kenyotter Whipple | Nurse Practitioner | 1400 Gray Hwy Apt 808, Macon, GA 31211-1931 | 2014-06-19 |
| 1174139281 | Joy Anne Safo | Nurse Practitioner | 175 Emery Hwy, Macon, GA 31217-3692 | 2020-09-23 |
| 1326419201 | Brenda Griffin | Nurse Practitioner | 340 Hospital Dr, Suite 370, Macon, GA 31217-3838 | 2015-10-16 |
| 1750707337 | Bryan Kelly Jaye | Nurse Practitioner | 175 Emery Hwy, Macon, GA 31217-3692 | 2014-03-06 |
| 1891771010 | Corrie Willis | Nurse Practitioner | 303 Weller St, Macon, MO 63552-1942 | 2005-12-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336740398 | Audline Maria Hodnett | Nurse Practitioner | 4805 W Village Way Se Apt 2208, Smyrna, GA 30080-9227 | 2020-11-05 |
| 1073111845 | George Mackel, Pmhnp-bc, LLC | Nurse Practitioner | 12034 Big Canoe, 400 Shetland Trace, Jasper, GA 30143 | 2020-10-14 |
| 1356958060 | Earl Delk | Nurse Practitioner | 3365 Ridgerock Way, Snellville, GA 30078-4176 | 2020-09-26 |
| 1609482991 | Tammy Haskins Bailey | Nurse Practitioner | 196 Laying Farm Rd Se, Milledgeville, GA 31061-9714 | 2020-09-22 |
| 1861007403 | Caring Clinic LLC | Nurse Practitioner | 114 Wrights Dr, Milledgeville, GA 31061 | 2020-09-10 |
| 1376156364 | Katrina Ransom Clark | Nurse Practitioner | 120 Walker Dr Nw, Milledgeville, GA 31061-9561 | 2020-08-28 |
| 1457963746 | Evelyn Ahiante Dennis | Nurse Practitioner | 3325 Emden Ct, Snellville, GA 30039-6047 | 2020-08-19 |
| 1194335620 | Jennifer Logan | Nurse Practitioner | 424 Scotts Way, Augusta, GA 30909-3135 | 2020-08-10 |
| 1750991592 | Jamie Rae Mccracken | Nurse Practitioner | 2538 Gordon Cir Se, Smyrna, GA 30080-8123 | 2020-08-06 |
| 1285244608 | Amcare Substance Abuse and Addiction Counseling | Nurse Practitioner | 3615 Hutchinson Rd Ste 203, Cumming, GA 30040-0501 | 2020-08-01 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.