Individual provider · Type 1 NPI

Samuel Stark, DO

Student in an Organized Health Care Education/Training Program · Johnson City, TN

NPI number 1376489807 Active

Practice location

400 N State Of Franklin Rd Ste 7303
Johnson City, TN 37604-6035

Call (423) 439-8805 Map

Fax (423) 439-6259

Specialties and licenses

TaxonomyCodeLicense
Student in an Organized Health Care Education/Training Program Primary 390200000XNone listed

Student in an Organized Health Care Education/Training Program: An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

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About NPI 1376489807

Samuel Stark, DO's National Provider Identifier is 1376489807, issued on Apr 27, 2026. The primary taxonomy on file is Student in an Organized Health Care Education/Training Program (390200000X), and the practice location is in Johnson City, TN. The record was last updated on Apr 27, 2026.