Provider Demographics
NPI:1104250448
Name:SAMUEL, AARON DOSS
Entity type:Individual
Prefix:DR
First Name:AARON
Middle Name:DOSS
Last Name:SAMUEL
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:AARON
Other - Middle Name:D
Other - Last Name:SAMUEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:3178 CHESTNUT CIR NW
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37312-2137
Mailing Address - Country:US
Mailing Address - Phone:423-339-3524
Mailing Address - Fax:
Practice Address - Street 1:3178 CHESTNUT CIR NW
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37312-2137
Practice Address - Country:US
Practice Address - Phone:423-339-3524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-22
Last Update Date:2013-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000027219207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNC29310Medicare UPIN