Provider Demographics
NPI:1023032083
Name:SMITH, GEORGE WALTON (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:WALTON
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 19TH ST
Mailing Address - Street 2:STE 401
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37916-1831
Mailing Address - Country:US
Mailing Address - Phone:865-331-1122
Mailing Address - Fax:865-331-1976
Practice Address - Street 1:501 19TH ST.
Practice Address - Street 2:SUITE 401
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37916-1839
Practice Address - Country:US
Practice Address - Phone:865-541-1975
Practice Address - Fax:865-541-1976
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2017-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN20625207VX0000X
TNMD0000020625207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3054343Medicaid
3054344Medicare PIN
TN103I165209Medicare PIN
TN3054343Medicaid