DR. SAMUEL HAILEMARIAM FANTAYE (NPI# 1336677186) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1336677186 |
| Entity Type | Individual |
| Full Name | DR. SAMUEL HAILEMARIAM FANTAYE |
| Credential | MD, MPH |
| Practice Address |
303 Parkway Dr Ne Atlanta GA 30312-1212 |
| Practice Telephone | (404) 265-4919 |
| Mailing Telephone | 4042654919 |
| Enumeration Date | 2017-05-24 |
| Last Update Date | 2017-05-24 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 390200000X | Student in an Organized Health Care Education/Training Program | Student, Health Care |
| Street Address |
303 PARKWAY DR NE |
| City | ATLANTA |
| State | GA |
| Zip Code | 30312-1212 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730188368 | Rhonda Latrice Martin | Pharmacist | 303 Parkway Dr Ne, Atlanta, GA 30312-1212 | 2005-07-15 |
| 1275162075 | Derek Stephen Duey | Student in an Organized Health Care Education/Training Program | 303 Parkway Dr Ne, Atlanta, GA 30312-1212 | 2020-04-03 |
| 1659909018 | Blake Thor Bendixen | Student in an Organized Health Care Education/Training Program | 303 Parkway Dr Ne, Atlanta, GA 30312-1239 | 2020-03-31 |
| 1902433246 | Tom John Albunian Mayuga | Student in an Organized Health Care Education/Training Program | 303 Parkway Dr Ne, Atlanta, GA 30312-1212 | 2020-03-25 |
| 1114558889 | Parie Jared | Emergency Medicine | 303 Parkway Dr Ne, Atlanta, GA 30312-1212 | 2020-01-30 |
| 1548808827 | Sarah Deslate | Nurse Anesthetist, Certified Registered | 303 Parkway Dr Ne, Atlanta, GA 30312-1212 | 2019-12-17 |
| 1639714686 | Nicolai Pineda | Physician Assistant | 303 Parkway Dr Ne, Atlanta, GA 30312-1239 | 2019-11-14 |
| 1659915510 | Jason Madariaga Cuaresma | Pharmacist | 303 Parkway Dr Ne, Atlanta, GA 30312-1212 | 2019-11-04 |
| 1770143398 | Ga U Kim | Anesthesiologist Assistant | 303 Parkway Dr Ne, Atlanta, GA 30312-1212 | 2019-06-17 |
| 1396302584 | Noah Dessalegn | Student in an Organized Health Care Education/Training Program | 303 Parkway Dr Ne, Atlanta, GA 30312-1212 | 2019-05-22 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770108516 | Bita Ranjbari | Physician Assistant | 659 Auburn Ave Se, Suite 505, Atlanta, GA 30312 | 2020-06-08 |
| 1609439629 | Adeyinka Edward Adeniyi | Student in an Organized Health Care Education/Training Program | Wellstar Atlanta Medical Center, 303 Parkway Drive Ne, 4th Floor, Internal Medicine Department, Atlanta, GA 30312 | 2019-04-16 |
| 1003378670 | James Spratt IIi | Student in an Organized Health Care Education/Training Program | 303 Parkway Drive, Ne, 4th Floor, Wellstar Atlanta Medical Center Department of Orthopaed, Atlanta, GA 30312 | 2019-04-03 |
| 1659833440 | Derrick Edward Wendler | Student in an Organized Health Care Education/Training Program | Wellstar Atlanta Medical Center Dpt of Orthopaedics, 303 Parkway Drive Ne, 4th Floor, Atlanta, GA 30312 | 2019-04-02 |
| 1336631266 | The Atlanta Small Business Training Consortium, Inc. | Local Education Agency (LEA) | 250 Georgia Ave Se Ste 207a, Atlanta, GA 30312 | 2018-06-06 |
| 1669960134 | Derek Mccranie | Student in an Organized Health Care Education/Training Program | 303 Parkway Drive, Atlanta, FL 30312 | 2018-04-30 |
| 1336646223 | Amy Ruth Williams | Nurse Practitioner | 383 Ralph Mcgill Blvd Ne Apt D, Atlanta, GA 30312 | 2018-04-09 |
| 1730689183 | Lisa Marie Margavage | Chiropractor | 720 Ralph Mcgill Blvd Ne Unit 210, Atlanta, GA 30312 | 2018-02-12 |
| 1922518836 | Rodney Aldridge | Registered Nurse | 250 Georgia Avenue, Suite 206, Atlanta, GA 30312 | 2017-10-05 |
| 1629599279 | Huda Hashim Elsamani Elsheikh | Student in an Organized Health Care Education/Training Program | 303 Parkway Dr Ne, Wellstar Atlanta Medical Center, Dept of Graduate Medical Education, Internal Medicine, Atlanta, GA 30312 | 2017-07-05 |
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| Taxonomy Code | 390200000X |
| Grouping | Student, Health Care |
| Classification | Student in an Organized Health Care Education/Training Program |
| An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |
| Notes: [1/1/2005: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417563909 | Josephine Almanzar | Student in an Organized Health Care Education/Training Program | 199 Armour Dr Ne Ste E, Atlanta, GA 30324-3973 | 2020-09-20 |
| 1013532597 | Ivy Elizabeth Cook | Student in an Organized Health Care Education/Training Program | 3121 Flowers Rd S Apt I, Atlanta, GA 30341-5648 | 2020-06-10 |
| 1265055495 | Jeffrey Quinn Taylor II | Student in an Organized Health Care Education/Training Program | 1365 Clifton Rd Ne # 2300b, Atlanta, GA 30322-1013 | 2020-05-21 |
| 1073134391 | Robert Shvarts | Student in an Organized Health Care Education/Training Program | 465 Memorial Dr Se Unit 346, Atlanta, GA 30312-2229 | 2020-04-27 |
| 1477173920 | Ryan William Flanagan | Student in an Organized Health Care Education/Training Program | 2591 Piedmont Rd Ne Apt 1531, Atlanta, GA 30324-6280 | 2020-04-24 |
| 1467071589 | Charles Thomas Reeder | Student in an Organized Health Care Education/Training Program | 1744 Logans Knl Ne, Atlanta, GA 30329-4100 | 2020-04-09 |
| 1548899743 | Chandni Patel | Student in an Organized Health Care Education/Training Program | 700 14th St Nw, Atlanta, GA 30318-5408 | 2020-04-08 |
| 1962031625 | Rachel Reed | Student in an Organized Health Care Education/Training Program | 1364 Clifton Rd Ne Ste H-100, Atlanta, GA 30322-1059 | 2020-04-05 |
| 1629606264 | Jasmine Donesha Shackelford | Student in an Organized Health Care Education/Training Program | Emory Family Medicine, 4500 North Shallowford Road, Atlanta, GA 30338 | 2020-03-30 |
| 1467080218 | Aminah Danielle Phelps | Student in an Organized Health Care Education/Training Program | 395 Saint Jacques Ct Sw, Atlanta, GA 30331-8434 | 2020-03-28 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.