Healthcare Provider Details

I. General information

NPI: 1053521401
Provider Name (Legal Business Name): RICHARD P SMITH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 03/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 NASHVILLE HWY
COLUMBIA TN
38401-1004
US

IV. Provider business mailing address

1600 NASHVILLE HWY
COLUMBIA TN
38401-1004
US

V. Phone/Fax

Practice location:
  • Phone: 931-388-8965
  • Fax: 931-840-8520
Mailing address:
  • Phone: 931-388-8965
  • Fax: 931-840-8520

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number42601
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD42601
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: