Provider Demographics
NPI:1063397370
Name:BANKS, SAMANTHA DENISE (CSFA)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:DENISE
Last Name:BANKS
Suffix:
Gender:F
Credentials:CSFA
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:DENISE
Other - Last Name:BROWNING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CSFA
Mailing Address - Street 1:1267 BRIARCLIFF RD
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31211-1705
Mailing Address - Country:US
Mailing Address - Phone:386-249-2458
Mailing Address - Fax:
Practice Address - Street 1:1267 GA-54
Practice Address - Street 2:#200
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214
Practice Address - Country:US
Practice Address - Phone:770-460-1900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-06
Last Update Date:2025-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA183796246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant