Healthcare Provider Details

I. General information

NPI: 1134233745
Provider Name (Legal Business Name): ERIC L SMITH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 11/08/2024
Certification Date: 11/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3173 KIRBY WHITTEN RD STE 104
BARTLETT TN
38134-2881
US

IV. Provider business mailing address

3173 KIRBY WHITTEN RD STE 104
BARTLETT TN
38134-2881
US

V. Phone/Fax

Practice location:
  • Phone: 901-737-1992
  • Fax: 901-309-8784
Mailing address:
  • Phone: 901-384-8040
  • Fax: 901-888-4748

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number032043
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: