Provider Demographics
NPI:1679537419
Name:MCLERRAN, SAMANTHA EASTERLY (MD)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:EASTERLY
Last Name:MCLERRAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:TN
Mailing Address - Zip Code:38570-1718
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
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-17
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN38505207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3895623Medicaid
TN3895623Medicaid
TN3895623Medicare ID - Type Unspecified