Provider Demographics
NPI:1043280274
Name:FEASTER, SAMUEL H (MD)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:H
Last Name:FEASTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 LAUREL AVE
Mailing Address - Street 2:SUITE N304
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37916-1810
Mailing Address - Country:US
Mailing Address - Phone:865-546-9484
Mailing Address - Fax:
Practice Address - Street 1:2001 LAUREL AVE
Practice Address - Street 2:SUITE N304
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37916-1810
Practice Address - Country:US
Practice Address - Phone:865-546-9484
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD215462085N0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3372353Medicaid
TN3372353Medicaid
TNE27297Medicare UPIN