Individual
SAMUEL W HUDDLESTON IV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2002 BROOKSIDE DRIVE, STE 201, KINGSPORT, TN 37660
(423) 245-7080
(423) 245-7875
Mailing address
2002 BROOKSIDE DRIVE, STE 201, KINGSPORT, TN 37660
(423) 245-7080
(423) 245-7875
Taxonomy
Speciality
Code
Description
License number
State
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
15029
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0070707
BCBS
—
01
—
15029
LIC
—
05
—
3032417
—
TN
01
—
384053
ANTHEM
—
01
—
5331096
AETNA
—
Enumeration date
07/13/2006
Last updated
03/07/2023
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