Healthcare Provider Details

I. General information

NPI: 1124043161
Provider Name (Legal Business Name): LESLIE EUGENE SMITH JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 05/11/2023
Certification Date: 05/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5100 POPLAR AVE STE 2222
MEMPHIS TN
38137-2207
US

IV. Provider business mailing address

1765 CHAPEL CREEK CV
CORDOVA TN
38016-2847
US

V. Phone/Fax

Practice location:
  • Phone: 901-377-5891
  • Fax: 901-384-8646
Mailing address:
  • Phone: 901-218-2552
  • Fax: 901-384-8646

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberMD04682
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0000024682
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: