Healthcare Provider Details

I. General information

NPI: 1053303685
Provider Name (Legal Business Name): MICHAEL LANCE SMITHERMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2005
Last Update Date: 01/19/2023
Certification Date: 01/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 CRESTVIEW PARK DR STE 206
DICKSON TN
37055-2856
US

IV. Provider business mailing address

127 CRESTVIEW PARK DR STE 206
DICKSON TN
37055-2856
US

V. Phone/Fax

Practice location:
  • Phone: 615-446-1377
  • Fax: 615-446-1367
Mailing address:
  • Phone: 615-446-1377
  • Fax: 615-446-1367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number045973
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: