MEDICARE: DENNIS SMALL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	172A00000X	Driver

General Provider Information

NPI Number	:	1366917650
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DENNIS SMALL

Provider Business Mailing Address
First Line	:	9160 HIGHWAY 64 STE 12-187
Second Line	:
City	:	LAKELAND
State	:	TN
Zip	:	38002-4766
Country	:	US
Telephone Number	:	901-205-9032
Fax Number	:	901-292-9032

Provider Business Practice Location Address
First Line	:	9160 HIGHWAY 64 STE 12-187
Second Line	:
City	:	LAKELAND
State	:	TN
Zip	:	38002-4766
Country	:	US
Telephone Number	:	901-205-9032
Fax Number	:	901-292-9032

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/12/2018
Last Update Date	:	10/12/2018

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Directions to “ DENNIS SMALL ” Practice Location

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