MEDICARE: MARISA WOODALL SMITH RD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	167733	KY
2	133V00000X	Registered Dietitian	LD006164	GA
3	133V00000X	Registered Dietitian	4093	AL
4	133V00000X	Registered Dietitian	3119	TN

General Provider Information

NPI Number	:	1316493083
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARISA WOODALL SMITH RD

Provider Business Mailing Address
First Line	:	615 MAIN ST STE M1
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37206-3603
Country	:	US
Telephone Number	:	615-709-0903
Fax Number	:	855-634-2216

Provider Business Practice Location Address
First Line	:	615 MAIN ST STE M1
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37206-3603
Country	:	US
Telephone Number	:	615-709-0903
Fax Number	:	855-634-2216

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2016
Last Update Date	:	02/04/2025

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Directions to “ MARISA WOODALL SMITH RD” Practice Location

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