Healthcare Provider Details

I. General information

NPI: 1891884821
Provider Name (Legal Business Name): STACY C SMITH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 04/23/2021
Certification Date: 04/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10524 E HIGHWAY 92
HEREFORD AZ
85615-8371
US

IV. Provider business mailing address

8060 WOLF RIVER BLVD
GERMANTOWN TN
38138-1727
US

V. Phone/Fax

Practice location:
  • Phone: 520-366-0300
  • Fax: 520-366-0440
Mailing address:
  • Phone: 901-271-1000
  • Fax: 901-271-4185

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD0000033840
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number33840
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: