Provider Demographics
NPI:1477845444
Name:HERRIOTT, SAMANTHA JO (DO)
Entity Type:Individual
Prefix:DR
First Name:SAMANTHA
Middle Name:JO
Last Name:HERRIOTT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37662-0009
Mailing Address - Country:US
Mailing Address - Phone:423-857-2066
Mailing Address - Fax:
Practice Address - Street 1:320 BRISTOL WEST BLVD
Practice Address - Street 2:STE 2C
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620-8772
Practice Address - Country:US
Practice Address - Phone:423-844-1399
Practice Address - Fax:423-877-1397
Is Sole Proprietor?:No
Enumeration Date:2011-05-10
Last Update Date:2015-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101019227207V00000X
TNDO2730207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology