Healthcare Provider Details

I. General information

NPI: 1639288293
Provider Name (Legal Business Name): RANDEL L SMITH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 05/27/2025
Certification Date: 05/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 HIGHWAY 70 E STE G
DICKSON TN
37055-2080
US

IV. Provider business mailing address

111 HIGHWAY 70 E STE G
DICKSON TN
37055-2080
US

V. Phone/Fax

Practice location:
  • Phone: 615-515-1900
  • Fax: 615-292-4633
Mailing address:
  • Phone: 615-515-1900
  • Fax: 615-292-4633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number73627
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number15148
License Number StateMS
# 3
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number15148
License Number StateMS
# 4
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number73627
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: