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General NPI Number Information
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NPI Number | 1437217197
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Entity Type | Individual
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Provider Name | MARLA LANE SMITH PAC
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Gender | Female
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Dates
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Enumeration Date | 12/05/2006
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Last Update Date | 09/26/2022
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Provider Practice Location Address
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Address Line | 107 NATCHEZ PARK DR
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City | DICKSON
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State | TN
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Zip | 37055-9013
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Country | US
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Telephone | 615-326-2960
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Fax |
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Provider Business Mailing Address
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Address Line | 1040 KENDALL FARMS DR
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City | HENDERSONVILLE
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State | TN
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Zip | 37075-9738
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Country | US
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Telephone | 615-293-0456
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA1466
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License Number State | TN
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