Healthcare Provider Details

I. General information

NPI: 1023011764
Provider Name (Legal Business Name): THOMAS ANDERSON SMITH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/26/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

186 HOSPITAL RD STE 300
WINCHESTER TN
37398-2473
US

IV. Provider business mailing address

186 HOSPITAL RD STE 300
WINCHESTER TN
37398-2473
US

V. Phone/Fax

Practice location:
  • Phone: 931-967-9680
  • Fax: 931-967-7362
Mailing address:
  • Phone: 931-967-9680
  • Fax: 931-967-7362

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number011440
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: