Individual
SAMUEL WILLIAM COOK III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PAC
Contact information
Practice address
2410 SUSANNAH STREET, JOHNSON CITY, TN 37601-1748
(423) 282-9011
(423) 282-0035
Mailing address
2410 SUSANNAH ST, JOHNSON CITY, TN 37601-1748
(423) 282-9011
(423) 282-0035
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
305
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1507032
—
TN
Enumeration date
10/05/2007
Last updated
12/16/2019
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