Individual
DR. SAMUEL JOHN OLSEN II
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
301 GRADY RD, ETOWAH, TN 37331-0325
(423) 263-2444
(423) 263-1553
Mailing address
PO BOX 325, ETOWAH, TN 37331-0325
(423) 263-2444
(423) 263-1553
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
039591
TN
207RS0010X
Sports Medicine (Internal Medicine) Physician
039591
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3330104
—
TN
01
—
4108690
BCBS
TN
01
—
P00237341
MEDICARE RR
TN
Enumeration date
04/21/2006
Last updated
11/07/2007
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