Healthcare Provider Details

I. General information

NPI: 1992818975
Provider Name (Legal Business Name): AUDREY MARCELLE SMITH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 11/02/2022
Certification Date: 11/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4409 CENTRAL AVENUE PIKE # 102103
KNOXVILLE TN
37912-4081
US

IV. Provider business mailing address

1441 SPRING PASS WAY
KNOXVILLE TN
37919-9044
US

V. Phone/Fax

Practice location:
  • Phone: 865-378-6929
  • Fax:
Mailing address:
  • Phone: 865-414-4151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD028569
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code2083A0300X
TaxonomyAddiction Medicine (Preventive Medicine) Physician
License NumberMD028569
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD028569
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: