Provider Demographics
NPI:1053867184
Name:SMITH COUNTY FAMILY MEDICAL LLC
Entity Type:Organization
Organization Name:SMITH COUNTY FAMILY MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:GREGORY
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:615-735-8008
Mailing Address - Street 1:8 NEW MIDDLETON HWY
Mailing Address - Street 2:STE A
Mailing Address - City:GORDONSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38563
Mailing Address - Country:US
Mailing Address - Phone:615-735-8008
Mailing Address - Fax:615-735-0008
Practice Address - Street 1:8 NEW MIDDLETON HWY
Practice Address - Street 2:STE A
Practice Address - City:GORDONSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38563
Practice Address - Country:US
Practice Address - Phone:615-735-8008
Practice Address - Fax:615-735-0008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-29
Last Update Date:2018-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN13604363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3342364Medicare UPIN