MEDICARE: JERRY LEE SMITH 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	208100000X	Physical Medicine & Rehabilitation Physician	MD0000026739	TN
2	2081P2900X	Pain Medicine (Physical Medicine & Rehabilitation) Physician	041960	GA
3	2081P2900X	Pain Medicine (Physical Medicine & Rehabilitation) Physician	MD26739	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	10076869	OTHER	GA	AMERIGROUP
2	4126985	OTHER	TN	BCBSTN
3	376910	OTHER	GA	WELLCARE

General Provider Information

NPI Number	:	1811957384
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JERRY LEE SMITH MD

Provider Business Mailing Address
First Line	:	1 SISKIN PLZ STE 101
Second Line	:
City	:	CHATTANOOGA
State	:	TN
Zip	:	37403-1306
Country	:	US
Telephone Number	:	423-803-2226
Fax Number	:	423-803-2222

Provider Business Practice Location Address
First Line	:	1 SISKIN PLZ STE 101
Second Line	:
City	:	CHATTANOOGA
State	:	TN
Zip	:	37403-1306
Country	:	US
Telephone Number	:	423-803-2226
Fax Number	:	423-803-2222

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

Provider Enumeration Date	:	03/27/2006
Last Update Date	:	08/10/2021

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Directions to “ JERRY LEE SMITH MD” Practice Location

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