Individual
SAMUEL L HARBOLDT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5301 VIRGINIA WAY, STE 300, BRENTWOOD, TN 37027-7541
(615) 221-4474
(615) 234-3774
Mailing address
5301 VIRGINIA WAY, STE 300, BRENTWOOD, TN 37027-7541
(615) 221-4474
(615) 234-3774
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
30412
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000013666
TLC TENNCARE
TN
01
—
119175
UNISON TENNCARE
TN
01
—
3101523
BLUE CROSS
TN
05
—
3837708
—
TN
05
—
64095235
—
KY
Enumeration date
09/25/2006
Last updated
07/08/2007
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