Healthcare Provider Details

I. General information

NPI: 1871516187
Provider Name (Legal Business Name): SUSAN ELIZABETH SMITHSON RD, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 LEBANON RD
MURFREESBORO TN
37129-1237
US

IV. Provider business mailing address

810 ONEILL CT
ROCKVALE TN
37153-4044
US

V. Phone/Fax

Practice location:
  • Phone: 615-867-6000
  • Fax:
Mailing address:
  • Phone: 615-867-4253
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number0000001497
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: