MEDICARE: DR. MARTHA J SMITH 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	207L00000X	Anesthesiology Physician	MD41211	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	620476822	OTHER		TAX ID

General Provider Information

NPI Number	:	1922035492
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARTHA J SMITH MD

Provider Business Mailing Address
First Line	:	1128 E WEISGARBER RD
Second Line	:	SUITE 100
City	:	KNOXVILLE
State	:	TN
Zip	:	37909-2674
Country	:	US
Telephone Number	:	865-579-0552
Fax Number	:	865-579-1154

Provider Business Practice Location Address
First Line	:	1128 E WEISGARBER RD
Second Line	:	SUITE 100
City	:	KNOXVILLE
State	:	TN
Zip	:	37909-2674
Country	:	US
Telephone Number	:	865-579-0552
Fax Number	:	865-579-1154

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

Provider Enumeration Date	:	06/28/2006
Last Update Date	:	08/25/2016

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Directions to “ DR. MARTHA J SMITH MD” Practice Location

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