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General NPI Number Information
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NPI Number | 1508929258
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Entity Type | Individual
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Provider Name | SAMUEL J KUYKENDALL M.D.
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Gender | Male
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Dates
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Enumeration Date | 12/17/2006
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Last Update Date | 02/19/2008
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Provider Practice Location Address
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Address Line | 1203 TROTWOOD AVE
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City | COLUMBIA
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State | TN
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Zip | 38401-4886
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Country | US
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Telephone | 931-388-1181
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Fax | 931-381-5302
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Provider Business Mailing Address
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Address Line | 1203 TROTWOOD AVE
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City | COLUMBIA
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State | TN
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Zip | 38401-4886
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Country | US
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Telephone | 931-388-1181
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Fax | 931-381-5302
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 621078139
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License Number State | TN
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