Healthcare Provider Details

I. General information

NPI: 1295078251
Provider Name (Legal Business Name): ROBERT VINCENT SMITH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2013
Last Update Date: 11/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

975 E. THIRD STREET ATTN: UNIVERSITY HOSPITALISTS
CHATTANOOGA TN
37403-2147
US

IV. Provider business mailing address

975 E. THIRD STREET ATTN: PROVIDER ENROLLMENT
CHATTANOOGA TN
37403-2147
US

V. Phone/Fax

Practice location:
  • Phone: 844-439-1729
  • Fax: 423-778-2108
Mailing address:
  • Phone: 844-439-1729
  • Fax: 423-778-2108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number56424
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number56424
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: