Provider Demographics
NPI:1104856517
Name:SMYRNA MEDICAL GROUP LLC
Entity Type:Organization
Organization Name:SMYRNA MEDICAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:P
Authorized Official - Last Name:GARVIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-459-5796
Mailing Address - Street 1:PO BOX 2367
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37133
Mailing Address - Country:US
Mailing Address - Phone:615-459-5796
Mailing Address - Fax:615-459-5546
Practice Address - Street 1:351 QUE CREEK CIRCLE
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:TN
Practice Address - Zip Code:37167
Practice Address - Country:US
Practice Address - Phone:615-459-5796
Practice Address - Fax:615-459-5546
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3711354Medicaid
TN3711354Medicare ID - Type Unspecified