Healthcare Provider Details

I. General information

NPI: 1225320047
Provider Name (Legal Business Name): ZECHARY CRAIG SMITH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2011
Last Update Date: 06/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2569 DOUGLASS AVE
MEMPHIS TN
38114-2532
US

IV. Provider business mailing address

2595 CENTRAL AVE
MEMPHIS TN
38104-5905
US

V. Phone/Fax

Practice location:
  • Phone: 901-701-2550
  • Fax: 901-260-8449
Mailing address:
  • Phone: 901-260-8500
  • Fax: 901-260-8590

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number49446
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: