Healthcare Provider Details

I. General information

NPI: 1063499895
Provider Name (Legal Business Name): STACY L SMITHSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/22/2005
Last Update Date: 10/28/2025
Certification Date: 10/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 N LORETTO RD
LEBANON KY
40033-1300
US

IV. Provider business mailing address

1621 W MORRIS BLVD STE A
MORRISTOWN TN
37813-2967
US

V. Phone/Fax

Practice location:
  • Phone: 270-692-6131
  • Fax:
Mailing address:
  • Phone: 423-492-7100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number22067
License Number StateNH
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberC4582
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number18049
License Number StateSC
# 4
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD198221
License Number StateOR
# 5
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number68868
License Number StateTN
# 6
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number18049
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: