MEDICARE: GUY LYNWOOD SMOAK IV MD

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	207Q00000X	Family Medicine Physician	18263	TN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
5	P00236241	OTHER	TN	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4104246	OTHER	TN	BLUE CROSS/BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1649238791
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GUY LYNWOOD SMOAK IV MD

Provider Business Mailing Address
First Line	:	1 BETHEL VALLEY RD
Second Line	:
City	:	OAK RIDGE
State	:	TN
Zip	:	37830-8050
Country	:	US
Telephone Number	:	865-574-9355
Fax Number	:	865-574-9353

Provider Business Practice Location Address
First Line	:	1 BETHEL VALLEY RD
Second Line	:
City	:	OAK RIDGE
State	:	TN
Zip	:	37830-8050
Country	:	US
Telephone Number	:	865-574-9355
Fax Number	:	865-574-9353

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

Provider Enumeration Date	:	05/01/2006
Last Update Date	:	10/14/2024

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