Healthcare Provider Details

I. General information

NPI: 1689825309
Provider Name (Legal Business Name): JOSEPH W SMITH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2008
Last Update Date: 08/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1721 NICHOLASVILLE RD
LEXINGTON KY
40503-1428
US

IV. Provider business mailing address

2550 WINDY HILL RD SE SUITE 206
MARIETTA GA
30067-8665
US

V. Phone/Fax

Practice location:
  • Phone: 859-252-6500
  • Fax: 859-252-3073
Mailing address:
  • Phone: 770-850-8464
  • Fax: 770-783-8026

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number52074
License Number StateMN
# 3
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberTP631
License Number StateKY
# 4
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberTP631
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: