Provider Demographics
NPI:1114924875
Name:SMALLMAN CARNES, JANEL (DPM)
Entity Type:Individual
Prefix:DR
First Name:JANEL
Middle Name:
Last Name:SMALLMAN CARNES
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 652
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEBURG
Mailing Address - State:TN
Mailing Address - Zip Code:38464-3534
Mailing Address - Country:US
Mailing Address - Phone:931-762-1155
Mailing Address - Fax:931-762-1155
Practice Address - Street 1:406 E GAINES ST
Practice Address - Street 2:
Practice Address - City:LAWRENCEBURG
Practice Address - State:TN
Practice Address - Zip Code:38464-3534
Practice Address - Country:US
Practice Address - Phone:931-762-1155
Practice Address - Fax:931-762-1155
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2013-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDPM000279213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0050628OtherBCBS OF TN
TN3351196Medicaid
TN3351196Medicaid
TN3351196Medicare PIN