Healthcare Provider Details

I. General information

NPI: 1891922191
Provider Name (Legal Business Name): SAMANTHA DIAN POLLARD MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2009
Last Update Date: 01/09/2023
Certification Date: 01/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

224 S PETERS RD STE 105
KNOXVILLE TN
37923-5207
US

IV. Provider business mailing address

PO BOX 15004
KNOXVILLE TN
37901-5004
US

V. Phone/Fax

Practice location:
  • Phone: 865-470-8844
  • Fax: 866-479-4403
Mailing address:
  • Phone: 865-541-8895
  • Fax: 865-633-4808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number52986
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: