MEDICARE: DR. LATANGELA SMITH D.O.

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	2084N0400X	Neurology Physician	2020-01868	NC
2	2084N0400X	Neurology Physician	81362-21	WI
3	2084N0400X	Neurology Physician	02007583A	IN
4	2084N0400X	Neurology Physician	OS20628	FL
5	2084N0400X	Neurology Physician	036167701	IL
6	2084N0400X	Neurology Physician	339921	LA
7	2084N0400X	Neurology Physician	0102205626	VA
8	2084N0400X	Neurology Physician	5495	TN
9	2084N0400X	Neurology Physician	2024031568	MO
10	2084N0400X	Neurology Physician	OP61554352	WA
11	2084N0400X	Neurology Physician	DO220907	OR
12	2084N0400X	Neurology Physician	25MA12057300	NJ
13	2084N0400X	Neurology Physician	99887	GA

General Provider Information

NPI Number	:	1790162493
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LATANGELA SMITH D.O.

Provider Business Mailing Address
First Line	:	1021 W OAKLAND AVE STE 310
Second Line	:
City	:	JOHNSON CITY
State	:	TN
Zip	:	37604-2192
Country	:	US
Telephone Number	:	423-302-6565
Fax Number	:

Provider Business Practice Location Address
First Line	:	1463 FINNEGAN LN # E
Second Line	:
City	:	NORTH BRUNSWICK
State	:	NJ
Zip	:	08902-5025
Country	:	US
Telephone Number	:	803-270-9499
Fax Number	:

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

Provider Enumeration Date	:	05/01/2015
Last Update Date	:	09/19/2025

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