Provider Demographics
NPI:1053607432
Name:HUDDLESTON, SAMUEL WINSTON V (MD)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:WINSTON
Last Name:HUDDLESTON
Suffix:V
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:820 LIBERTY BELL BLVD
Mailing Address - Street 2:APT 6
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-3773
Mailing Address - Country:US
Mailing Address - Phone:423-895-1217
Mailing Address - Fax:
Practice Address - Street 1:408 N STATE OF FRANKLIN RD
Practice Address - Street 2:SUITE 31
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-6089
Practice Address - Country:US
Practice Address - Phone:423-431-2478
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-23
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN491582085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology