Provider Demographics
NPI:1528715364
Name:HOLCOMB, SAMANTHA DANYELL (RT (R), RDMS)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:DANYELL
Last Name:HOLCOMB
Suffix:
Gender:F
Credentials:RT (R), RDMS
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:
Other - Last Name:HUTCHESON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RT (R), RDMS
Mailing Address - Street 1:580 WILLOW CREEK CV NE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37323-4204
Mailing Address - Country:US
Mailing Address - Phone:423-290-0473
Mailing Address - Fax:
Practice Address - Street 1:1060 PEERLESS XING NW STE 200
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37312-3785
Practice Address - Country:US
Practice Address - Phone:423-380-6155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-02
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5338312085R0202X
TN1945682085U0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology