Provider Demographics
NPI:1598883472
Name:FITZPATRICK, SAMUEL R JR (DIPLOM,RES)
Entity Type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:R
Last Name:FITZPATRICK
Suffix:JR
Gender:M
Credentials:DIPLOM,RES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1944 BROOKSIDE DR
Mailing Address - Street 2:SUITE 3
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-4618
Mailing Address - Country:US
Mailing Address - Phone:423-230-0005
Mailing Address - Fax:
Practice Address - Street 1:1944 BROOKSIDE DR
Practice Address - Street 2:SUITE 3
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-4618
Practice Address - Country:US
Practice Address - Phone:423-230-0005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNACO0000000006171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist