Individual
DR. SAMUEL C POLK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
7900 AIRWAYS BLVD STE 2, SOUTHAVEN, MS 38671-4113
(601) 420-2040
(855) 343-5763
Mailing address
PO BOX 649113, DALLAS, TX 75264-9113
(903) 571-3844
(855) 343-5763
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
34003
MS
208100000X
Physical Medicine & Rehabilitation Physician
41433
TN
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
34003
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
34003
MEDICAL LICENSE
MS
01
—
41433
MEDICAL LICENSE
TN
Enumeration date
09/05/2006
Last updated
06/25/2025
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