Provider Demographics
NPI:1124043161
Name:SMITH, LESLIE EUGENE JR (MD)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:EUGENE
Last Name:SMITH
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1765 CHAPEL CREEK CV
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38016-2847
Mailing Address - Country:US
Mailing Address - Phone:901-218-2552
Mailing Address - Fax:901-384-8646
Practice Address - Street 1:5100 POPLAR AVE STE 2222
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38137-2207
Practice Address - Country:US
Practice Address - Phone:901-377-5891
Practice Address - Fax:901-384-8646
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD046822084P0804X
TN00000246822084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3077434Medicaid
TN3077434Medicaid
E-32861Medicare UPIN