Active NPI
Samantha Ann Liddy, ATC
- Athletic Trainer
- Kingsland, GA
National Provider Identifier
1366753733
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- AL2498
- Practice address
- 100 A Lindsey Lane
Kingsland, GA 31548-0000 - Phone
- (912) 729-1333
- Fax
- (912) 729-5259
- NPI assigned
- Jun 30, 2010
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | AT001475 | GA | |
| Athletic Trainer | 2255A2300X | AL2498 | FL | Primary |
Addresses
Primary practice location
100 A Lindsey Lane
Kingsland, GA 31548-0000
Mailing address
PO Box 949
Rome, GA 30162-0949
Phone (706) 802-1991
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| AL2498 | Other | FL | LICENSES |
| AT001475 | Other | GA | LICENSES |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AL2498 | FL | MD | Athletic Trainer |
| AT001475 | GA | MD | Athletic Trainer |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Advance Rehabilitation and Consulting | Athletic Trainer | Past | Accepting new patients |
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1277856000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1277856000000",
"number": "1366753733",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 949",
"city": "ROME",
"state": "GA",
"postal_code": "301620949",
"telephone_number": "706-802-1991",
"fax_number": "706-802-1408"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 A LINDSEY LANE",
"city": "KINGSLAND",
"state": "GA",
"postal_code": "315480000",
"telephone_number": "912-729-1333",
"fax_number": "912-729-5259"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LIDDY",
"first_name": "SAMANTHA",
"middle_name": "ANN",
"credential": "ATC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-06-30",
"last_updated": "2010-06-30",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "GA",
"license": "AT001475",
"primary": false
},
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "FL",
"license": "AL2498",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSES",
"identifier": "AL2498",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSES",
"identifier": "AT001475",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Kingsland, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.