Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Samuel Kissiedu

Individual provider Physician Assistant · NPI 1235917154

Samuel Kissiedu is a Physician Assistant in Chamblee, Georgia. Qualified in 2024, 2 years ago. Registered with an NPI since 2023.

Years since qualifying
2
In the registry since
2023

Practice location Address checks out

6102 Jefferson Cir S
Chamblee, GA 30341-2661
Phone: (321) 274-5712
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X

Record details

NPI number1235917154
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedSeptember 20, 2023
Last updated in NPPESSeptember 20, 2023
Certification dateSeptember 20, 2023

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2024 (2 years in practice)
Accepts Medicare assignment Not indicated

Other providers in Chamblee