Provider Demographics
NPI:1003881061
Name:SMITH, BILL MOORE JR (MD)
Entity Type:Individual
Prefix:
First Name:BILL
Middle Name:MOORE
Last Name:SMITH
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:632 MORRISON SPRINGS ROAD
Mailing Address - Street 2:SUITE #202
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37415
Mailing Address - Country:US
Mailing Address - Phone:423-778-3390
Mailing Address - Fax:423-778-3391
Practice Address - Street 1:632 MORRISON SPRINGS ROAD
Practice Address - Street 2:SUITE #202
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37415
Practice Address - Country:US
Practice Address - Phone:423-778-3390
Practice Address - Fax:423-778-3391
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2020-01-03
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Provider Licenses
StateLicense IDTaxonomies
TN20573207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1522960Medicaid
TN3711170Medicare ID - Type UnspecifiedGROUP MCARE NUMBER
TNB06347Medicare UPIN