Healthcare Provider Details

I. General information

NPI: 1649226895
Provider Name (Legal Business Name): PAUL E SMITH III DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 HIGHWAY 15 S STE 200
JACKSON KY
41339-0714
US

IV. Provider business mailing address

6 FONTAINE BLVD
WINCHESTER KY
40391-9216
US

V. Phone/Fax

Practice location:
  • Phone: 606-666-8404
  • Fax:
Mailing address:
  • Phone: 231-742-1213
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number03402
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number03402
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: