Healthcare Provider Details

I. General information

NPI: 1215078795
Provider Name (Legal Business Name): TONY DWAYNE SMITH D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

71 WHEELERTOWN AVE
PIKEVILLE TN
37367-5246
US

IV. Provider business mailing address

708 BELVOIR AVE
EAST RIDGE TN
37412-2604
US

V. Phone/Fax

Practice location:
  • Phone: 423-447-2112
  • Fax:
Mailing address:
  • Phone: 423-309-5088
  • Fax: 423-209-3724

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberDO1137
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDO1137
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: