Samantha Elizabeth Wilson, MASSAGE THERAPIST

Primary specialty

Massage TherapistTaxonomy code 225700000X

License

MT004816 Issued in GA

Practice address

2185 Northlake Pkwy Ste 100
Tucker, GA 30084-4100

Phone

(770) 493-6360

Fax

(770) 493-6350

NPI assigned

May 7, 2013

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• All Health Physical Therapy

  • Orthopedic Physical Therapist
  • Tucker, GA
  • NPI 1295170868
  NPD (past)
• All Health Physical Therapy Inc

  • Physical Therapist
  • Tucker, GA
  • NPI 1336176213
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1367884800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1367884800000",
    "number": "1295170959",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2185 NORTHLAKE PKWY STE 100",
            "city": "TUCKER",
            "state": "GA",
            "postal_code": "300844100",
            "telephone_number": "770-493-6360",
            "fax_number": "770-493-6350"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2185 NORTHLAKE PKWY STE 100",
            "city": "TUCKER",
            "state": "GA",
            "postal_code": "300844100",
            "telephone_number": "770-493-6360",
            "fax_number": "770-493-6350"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "SAMANTHA",
        "middle_name": "ELIZABETH",
        "name_prefix": "Ms.",
        "credential": "MASSAGE THERAPIST",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-05-07",
        "last_updated": "2013-05-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "GA",
            "license": "MT004816",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE NUMBER",
            "identifier": "MT004816",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jacqueline D Wilson, PT
• Jerry Dewayne Wilson, PA-C
• Kristin Nicole Wilson, DMD
• Patricia Wilson
• Rosemarie Wilson, CASE MANAGER
• Jeremy Dewayne Winbush, COTA
• Monique Wischusen
• Louise Wise, DNP, PMHNP-BC
• P Lynn Wiseman, CNS
• Michael Witmer, MAT, LAT, ATC, CPT

• Massage Therapist in Tucker, GA
• Providers in Tucker, GA by specialty
• Massage Therapist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.