Provider Demographics
NPI:1821253899
Name:HARRIS, SAMUEL T (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:T
Last Name:HARRIS
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 1:3314 OCTOBER LN
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37931-3596
Mailing Address - Country:US
Mailing Address - Phone:865-474-1154
Mailing Address - Fax:
Practice Address - Street 1:8045 ROANE MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:HARRIMAN
Practice Address - State:TN
Practice Address - Zip Code:37748-8333
Practice Address - Country:US
Practice Address - Phone:865-316-3375
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-18
Last Update Date:2015-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN48753207R00000X
LAMD.204060207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine