Provider Demographics
NPI:1720150840
Name:MCGAHA, SAMUEL W (MD)
Entity Type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:W
Last Name:MCGAHA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1235 DOLLY PARTON PARKWAY
Mailing Address - Street 2:SUITE #2
Mailing Address - City:SEVIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37862
Mailing Address - Country:US
Mailing Address - Phone:865-428-6088
Mailing Address - Fax:865-774-9745
Practice Address - Street 1:1235 DOLLY PARTON PARKWAY
Practice Address - Street 2:SUITE # 2
Practice Address - City:SEVIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:37862
Practice Address - Country:US
Practice Address - Phone:865-428-6088
Practice Address - Fax:865-774-9745
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD010012207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3169423Medicaid
2009938OtherBCBS
B03344Medicare UPIN
2009938OtherBCBS