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Individual

DR. SAMUEL MACK PUCKETT

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
1829 CROWE LN, NEWPORT, TN 37821-7264
(423) 623-0653
(423) 625-8264
Mailing address
1829 CROWE LN, NEWPORT, TN 37821-7264
(423) 623-0653
(423) 625-8264

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
MD16317
TN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
3015182
TN
Enumeration date
07/17/2006
Last updated
01/20/2010
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