Provider Demographics
NPI:1366751240
Name:YOAKUM, SAMUEL A (DO)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:A
Last Name:YOAKUM
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 306556
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37230-6556
Mailing Address - Country:US
Mailing Address - Phone:865-243-8153
Mailing Address - Fax:
Practice Address - Street 1:9430 PARK WEST BLVD STE 130
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-4205
Practice Address - Country:US
Practice Address - Phone:865-694-8353
Practice Address - Fax:865-693-0338
Is Sole Proprietor?:No
Enumeration Date:2010-09-27
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2482208100000X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1531839Medicaid
TN103I254046Medicare PIN
TN103I254041Medicare PIN
TN1531839Medicaid
TN0677340003Medicare NSC
TN103I254049Medicare PIN
TN103I254044Medicare PIN
TN0677340002Medicare NSC
TN0677340001Medicare NSC
TN103I254040Medicare PIN