Healthcare Provider Details

I. General information

NPI: 1922095561
Provider Name (Legal Business Name): JEFFREY GALT SMITH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2005
Last Update Date: 05/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 E BROOKLYN ST
LINDEN TN
37096-3515
US

IV. Provider business mailing address

115 E BROOKLYN ST P.O. BOX 916
LINDEN TN
37096-3515
US

V. Phone/Fax

Practice location:
  • Phone: 931-589-2104
  • Fax: 931-589-2513
Mailing address:
  • Phone: 931-589-2104
  • Fax: 931-589-2513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number9601143
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number021861
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: