Healthcare Provider Details

I. General information

NPI: 1003881061
Provider Name (Legal Business Name): BILL MOORE SMITH JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2006
Last Update Date: 01/03/2020
Certification Date: 01/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

632 MORRISON SPRINGS ROAD SUITE #202
CHATTANOOGA TN
37415
US

IV. Provider business mailing address

632 MORRISON SPRINGS ROAD SUITE #202
CHATTANOOGA TN
37415
US

V. Phone/Fax

Practice location:
  • Phone: 423-778-3390
  • Fax: 423-778-3391
Mailing address:
  • Phone: 423-778-3390
  • Fax: 423-778-3391

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number20573
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: