MEDICARE: MS. GRACE MARIE SMITH LMT

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	172V00000X	Community Health Worker	0000006739	TN

General Provider Information

NPI Number	:	1730328436
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. GRACE MARIE SMITH LMT

Provider Business Mailing Address
First Line	:	1009 MANLEY ST
Second Line	:
City	:	PARIS
State	:	TN
Zip	:	38242-4915
Country	:	US
Telephone Number	:	713-584-1430
Fax Number	:	731-584-1439

Provider Business Practice Location Address
First Line	:	30 E MAIN ST
Second Line	:
City	:	CAMDEN
State	:	TN
Zip	:	38320-1734
Country	:	US
Telephone Number	:	731-584-1430
Fax Number	:	731-584-1439

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

Provider Enumeration Date	:	02/19/2009
Last Update Date	:	02/19/2009

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