1. Home
  2. Directory
  3. Georgia
  4. Chamblee
  5. Physician Assistant
  6. NPI Profile

SAMUEL KISSIEDU
NPI 1235917154
Physician Assistant in Chamblee, GA

Active since September 20, 2023PECOS Enrolled
6102 JEFFERSON CIR S, CHAMBLEE, GA 30341(321) 274-5712 Get Directions Write a Review

NPPES record last updated: September 20, 2023. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Samuel Kissiedu NPPES

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

SAMUEL KISSIEDU (NPI 1235917154) is an individual physician assistant in Chamblee, Georgia and active in the NPI registry since September 2023. He is enrolled in Medicare PECOS and is a graduate of Other (2024).

NPPES Registry Identity

NPI1235917154
Entity TypeIndividualMale
Primary Taxonomy363A00000X
Provider Legal NameSAMUEL KISSIEDU
Location Address6102 JEFFERSON CIR SChamblee, GA 30341-2661
Mailing Address6102 Jefferson Cir SChamblee, GA 30341-2661 · (321) 274-5712
Phone(321) 274-5712
Sole ProprietorNo
Medical School CMSOtherGraduated 2024
Enumeration DateSeptember 20, 2023
NPPES CertifiedSeptember 20, 2023
✔ NPI 1235917154 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysician AssistantPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363A00000X
Definition
A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.
6102 JEFFERSON CIR S, Chamblee, GA 30341
Open in Google Maps ↗

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Samuel Kissiedu is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID6406326081
PECOS Enrollment IDI20260525000396
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 30341 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
$70.85 typical visit price
range $18.22 – $140.40
Typical copayment $17.71 (range $4.55 – $35.10)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Samuel Kissiedu's NPI number?

The NPI number for Samuel Kissiedu is 1235917154. It was assigned to this individual provider in the NPPES registry on September 20, 2023.

Where is Samuel Kissiedu located?

Samuel Kissiedu practices at 6102 Jefferson Cir S, Chamblee, GA 30341. The listed phone number is (321) 274-5712.

What is Samuel Kissiedu's specialty?

The primary specialty registered for this NPI is Physician Assistant with taxonomy code 363A00000X.

Is Samuel Kissiedu enrolled in Medicare?

Yes. Samuel Kissiedu is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Samuel Kissiedu was last updated on September 20, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.