Provider Demographics
NPI:1124224670
Name:SAMANTHA E. MCLERRAN, M. D. PLLC
Entity Type:Organization
Organization Name:SAMANTHA E. MCLERRAN, M. D. PLLC
Other - Org Name:SAMANTHA E. MCLERRAN, M.D.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:EASTERLY
Authorized Official - Last Name:MCLERRAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:931-823-5681
Mailing Address - Street 1:PO BOX 609
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:TN
Mailing Address - Zip Code:38570-0609
Mailing Address - Country:US
Mailing Address - Phone:931-823-5681
Mailing Address - Fax:931-823-8203
Practice Address - Street 1:500 W MAIN ST
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:TN
Practice Address - Zip Code:38570-1718
Practice Address - Country:US
Practice Address - Phone:931-823-5681
Practice Address - Fax:931-823-8203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-22
Last Update Date:2007-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN38505207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3725755Medicaid
TN3725755Medicaid
TNH78463Medicare UPIN