MEDICARE: DR. LOVELL BERNARD SMITH JR. MD

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	208600000X	Surgery Physician	39730	TN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	103I021824	OTHER	TN	MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	4313546	OTHER	TN	BS TN
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1528064789
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LOVELL BERNARD SMITH JR. MD

Provider Business Mailing Address
First Line	:	554 GREEN TREE CV STE 202
Second Line	:
City	:	COLLIERVILLE
State	:	TN
Zip	:	38017-2551
Country	:	US
Telephone Number	:	901-570-1775
Fax Number	:	833-765-0928

Provider Business Practice Location Address
First Line	:	554 GREEN TREE CV
Second Line	:	STE 202
City	:	COLLIERVILLE
State	:	TN
Zip	:	38017-2551
Country	:	US
Telephone Number	:	901-570-1775
Fax Number	:	901-853-4530

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

Provider Enumeration Date	:	06/22/2005
Last Update Date	:	02/26/2026

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Directions to “ DR. LOVELL BERNARD SMITH JR. MD” Practice Location

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