Samantha N Pettaway

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

3812C Issued in AL

Practice address

13833 Tapia Ave
Bayou la Batre, AL 36509-2515

Phone

(251) 450-2211

NPI assigned

Aug 14, 2015

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Interoperability endpoints

• Direct secure messaging: samantha.pettaway.p1@direct.accordiahealth.nextgenshare.com

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

{
    "created_epoch": "1439510400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1591228800000",
    "number": "1629444583",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5750A SOUTHLAND DR",
            "city": "MOBILE",
            "state": "AL",
            "postal_code": "366933316",
            "telephone_number": "251-450-5095"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13833 TAPIA AVE",
            "city": "BAYOU LA BATRE",
            "state": "AL",
            "postal_code": "365092515",
            "telephone_number": "251-450-2211"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETTAWAY",
        "first_name": "SAMANTHA",
        "middle_name": "N",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-08-14",
        "last_updated": "2020-06-04",
        "certification_date": "2020-06-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "AL",
            "license": "3812C",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• J. Watkins Drugs, LLC
• Kimberley E Jongebloed, MD
• Chelsea McCormick
• Modern Drug of Bayou la Batre Inc
• Adam McCay Moore, PHARMD
• Mary Ashley Roberts, MS CCC SLP
• RX Express Pharmacy of Bayou la Batre, Inc.
• Staci L. Shipman, PHARMD
• Joseph Hunter Steiner
• Meghan Elizabeth Stinnette Elmore

• Clinical Social Worker in Bayou la Batre, AL
• Providers in Bayou la Batre, AL by specialty
• Clinical Social Worker in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2020; 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.