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General NPI Number Information
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NPI Number | 1164846135
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Entity Type | Organization
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Legal Business Name | BRIDGES W. SMITH, P.C.
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Dates
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Enumeration Date | 02/12/2014
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Last Update Date | 02/12/2014
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Provider Practice Location Address
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Address Line | 1241 VOLUNTEER PKWY STE 436
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City | BRISTOL
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State | TN
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Zip | 37620-4659
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Country | US
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Telephone | 423-990-2315
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Fax | 423-990-2316
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Provider Business Mailing Address
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Address Line | 1241 VOLUNTEER PKWY STE 436
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City | BRISTOL
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State | TN
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Zip | 37620-4659
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Country | US
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Telephone | 423-990-2315
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Fax | 423-990-2316
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Authorized Official
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Title or Position | SENIOR PSYCHOLOGICAL EXAMINER
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Name | MR. BRIDGES WADE SMITH III
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Credential | M.S., LSPE
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Telephone | 423-990-2315
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number | 11716
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 11716
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License Number State | TN
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