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General NPI Number Information
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NPI Number | 1790004646
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Entity Type | Individual
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Provider Name | SAMUEL ANDREW POLEK M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/18/2010
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Last Update Date | 10/10/2023
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Provider Practice Location Address
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Address Line | 128 N 2ND ST STE 202
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City | CLARKSVILLE
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State | TN
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Zip | 37040-6460
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Country | US
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Telephone | 866-219-2688
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Fax | 423-523-0994
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Provider Business Mailing Address
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Address Line | 3840 REDDICK RD
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City | PALMYRA
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State | TN
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Zip | 37142-2141
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Country | US
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Telephone | 256-499-1629
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Fax |
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | MD.32824
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License Number State | AL
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