Healthcare Provider Details

I. General information

NPI: 1144756800
Provider Name (Legal Business Name): HALEY SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2017
Last Update Date: 06/24/2020
Certification Date: 06/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1559 SPARTA ST
MCMINNVILLE TN
37110-1316
US

IV. Provider business mailing address

1559 SPARTA ST
MCMINNVILLE TN
37110-1316
US

V. Phone/Fax

Practice location:
  • Phone: 931-815-4000
  • Fax:
Mailing address:
  • Phone: 931-815-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number59954
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: