Healthcare Provider Details

I. General information

NPI: 1093635435
Provider Name (Legal Business Name): SAMUEL KADE DABBS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2026
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 JI BELL LN
SAVANNAH TN
38372-5110
US

IV. Provider business mailing address

175 JI BELL LN
SAVANNAH TN
38372-5110
US

V. Phone/Fax

Practice location:
  • Phone: 731-925-2506
  • Fax:
Mailing address:
  • Phone: 731-925-2506
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number49942
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: