Provider Demographics
NPI:1790004646
Name:POLEK, SAMUEL ANDREW (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:ANDREW
Last Name:POLEK
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 1:3840 REDDICK RD
Mailing Address - Street 2:
Mailing Address - City:PALMYRA
Mailing Address - State:TN
Mailing Address - Zip Code:37142-2141
Mailing Address - Country:US
Mailing Address - Phone:256-499-1629
Mailing Address - Fax:
Practice Address - Street 1:128 N 2ND ST STE 202
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37040-6460
Practice Address - Country:US
Practice Address - Phone:866-219-2688
Practice Address - Fax:423-523-0994
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-18
Last Update Date:2023-10-10
Deactivation Date:2018-03-27
Deactivation Code:
Reactivation Date:2018-04-18
Provider Licenses
StateLicense IDTaxonomies
ALMD.328242084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry