Healthcare Provider Details

I. General information

NPI: 1184369175
Provider Name (Legal Business Name): SULLIVAN DANIEL SMOAK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2022
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5491 CREEKWOOD PARK BLVD
LENOIR CITY TN
37772-1204
US

IV. Provider business mailing address

1275 DICK LONAS RD
KNOXVILLE TN
37909-1326
US

V. Phone/Fax

Practice location:
  • Phone: 800-500-4667
  • Fax: 833-448-2983
Mailing address:
  • Phone: 865-584-4747
  • Fax: 865-381-1509

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number76451
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: