Provider Demographics
NPI:1891338133
Name:HALE, SAMUEL MATTHEWS (CPO)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:MATTHEWS
Last Name:HALE
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:712 MORNING SHADOWS DR
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-2055
Mailing Address - Country:US
Mailing Address - Phone:423-605-8222
Mailing Address - Fax:
Practice Address - Street 1:2710 AMNICOLA HWY
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37406-3603
Practice Address - Country:US
Practice Address - Phone:423-624-0946
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-18
Last Update Date:2019-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN221222Z00000X
GA120224P00000X
TN200224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist