Provider Demographics
NPI:1053947697
Name:HARTMAN, SAMANTHA DEANE (MS)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:DEANE
Last Name:HARTMAN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 HAMPTON DR
Mailing Address - Street 2:
Mailing Address - City:SANDY SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30350-3901
Mailing Address - Country:US
Mailing Address - Phone:478-919-8293
Mailing Address - Fax:
Practice Address - Street 1:10700 STATE BRIDGE RD STE 6
Practice Address - Street 2:
Practice Address - City:JOHNS CREEK
Practice Address - State:GA
Practice Address - Zip Code:30022-7491
Practice Address - Country:US
Practice Address - Phone:770-802-8019
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-16
Last Update Date:2020-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC00702101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor