Healthcare Provider Details

I. General information

NPI: 1144215666
Provider Name (Legal Business Name): TELITHA DONET GLASSCOCK D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2005
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 N CONGRESS BLVD
SMITHVILLE TN
37166-2704
US

IV. Provider business mailing address

302 N CONGRESS BLVD
SMITHVILLE TN
37166-2704
US

V. Phone/Fax

Practice location:
  • Phone: 615-597-4395
  • Fax: 615-597-4393
Mailing address:
  • Phone: 615-597-4395
  • Fax: 615-597-4393

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number6294
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number1715
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: