Individual
SAMUEL O MASSEY III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1301 SUNSET DR, STE 3, JOHNSON CITY, TN 37604-7906
(423) 926-4966
(423) 926-1823
Mailing address
1301 SUNSET DR, STE 3, JOHNSON CITY, TN 37604-7906
(423) 926-4966
(423) 926-1823
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
31318
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
100026452
PHP TNCARE
TN
05
—
1912956277
—
VA
01
—
300104374
RAILROAD MEDICARE
TN
01
—
3125936
BCBS
TN
05
—
3840825
—
TN
01
—
64017064
KENTUCKY MEDICAID
KY
01
—
7222238
VIRGINIA MEDICAID
VA
01
—
89063JF
NORTH CAROLINA MEDICAID
NC
05
—
Q007699
—
TN
Enumeration date
05/06/2006
Last updated
02/16/2017
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