MEDICARE: JERRY SMITH JR.

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	101YM0800X	Mental Health Counselor	2895	TN

General Provider Information

NPI Number	:	1629501820
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JERRY SMITH JR.

Provider Business Mailing Address
First Line	:	5509 CLIFFWOOD RD
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37921-2410
Country	:	US
Telephone Number	:	423-616-0213
Fax Number	:

Provider Business Practice Location Address
First Line	:	2928 E MAGNOLIA AVE
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37914-4515
Country	:	US
Telephone Number	:	865-394-9075
Fax Number	:

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

Provider Enumeration Date	:	04/05/2017
Last Update Date	:	06/18/2026

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