Provider Demographics
NPI:1073779930
Name:SMITH, DUSTIN WELLES (MD)
Entity Type:Individual
Prefix:
First Name:DUSTIN
Middle Name:WELLES
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 1:4601 CAROTHERS PKWY
Mailing Address - Street 2:SUITE 360
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-5976
Mailing Address - Country:US
Mailing Address - Phone:615-794-8900
Mailing Address - Fax:615-794-0038
Practice Address - Street 1:4601 CAROTHERS PKWY
Practice Address - Street 2:SUITE 360
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-5976
Practice Address - Country:US
Practice Address - Phone:615-794-8900
Practice Address - Fax:615-794-0038
Is Sole Proprietor?:No
Enumeration Date:2008-07-31
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN45112208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN32849682Medicare PIN
TN3042110Medicare PIN