Provider Demographics
NPI:1245341403
Name:SELLS, SAMUEL PAUL JR (MD)
Entity type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:PAUL
Last Name:SELLS
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 767
Mailing Address - Street 2:
Mailing Address - City:SHELBYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37162
Mailing Address - Country:US
Mailing Address - Phone:931-684-2770
Mailing Address - Fax:931-684-2774
Practice Address - Street 1:1701 NORTH MAIN STREET
Practice Address - Street 2:SUITE A
Practice Address - City:SHELBYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37160
Practice Address - Country:US
Practice Address - Phone:931-684-2770
Practice Address - Fax:931-684-2774
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNMD10299207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0004328OtherBCBS OF TN
2771119OtherCIGNA
2771119OtherCIGNA