MS. SAMANTHA F FREDERICK NP-C
NPI 1124614631
Nurse Practitioner in Canton, GA

Q: What is Samantha Frederick's NPI number?

The NPI number for Samantha Frederick is 1124614631. It was assigned to this individual provider in the NPPES registry on December 18, 2020.

Q: What is Samantha Frederick's specialty?

The primary specialty registered for this NPI is Nurse Practitioner with taxonomy code 363L00000X.

Active since December 18, 2020PECOS Enrolled

228 RIVERSTONE DR, CANTON, GA 30114(770) 479-1870(770) 479-9705 Get Directions Write a Review

NPPES record last updated: September 30, 2021. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: Sep 30, 2021, Feb 25, 2021, Dec 18, 2020 (3 updates tracked since 2020).

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About Ms. Samantha F Frederick Np-c NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MS. SAMANTHA F FREDERICK NP-C (NPI 1124614631) is an individual nurse practitioner in Canton, Georgia, licensed in Georgia (RN203567) and active in the NPI registry since December 2020. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1124614631

Entity TypeIndividualFemale

Primary Taxonomy363L00000X

Provider Legal NameMS. SAMANTHA F FREDERICKCredential: NP-C

Location Address228 RIVERSTONE DRCanton, GA 30114-5256

Mailing Address1835 Savoy Dr Ste 300Atlanta, GA 30341-1071 · (678) 288-9555 · Fax (770) 479-1870

Phone(770) 479-1870

Fax(770) 479-9705

Sole ProprietorNo

Enumeration DateDecember 18, 2020

Last NPPES UpdateSeptember 30, 20213 updates tracked since enumeration

NPPES CertifiedSeptember 30, 2021

✔ NPI 1124614631 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse PractitionerPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363L00000X

License✔ Licensed in GA · RN203567

Definition

(1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners.

228 RIVERSTONE DR, Canton, GA 30114

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Other Identifiers 3

Medicaid003245264BGA

Medicaid003245264AGA

OtherG24488AGA · Medicare Ptan

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Ms. Samantha F Frederick Np-c is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 30114 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$88.06 typical visit price

range $56.84 – $172.43

Typical copayment $22.01 (range $14.21 – $43.10)

Most-billed visit code 99203

Established Patient

$100.20 typical visit price

range $18.22 – $140.40

Typical copayment $25.05 (range $4.55 – $35.10)

Most-billed visit code 99214

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 5

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. NAVNEET DHILLON M.D.

Internal Medicine (Hematology & Oncology)