Provider Demographics
NPI:1164846135
Name:BRIDGES W. SMITH, P.C.
Entity Type:Organization
Organization Name:BRIDGES W. SMITH, P.C.
Other - Org Name:BRISTOL EVALUATION SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:SENIOR PSYCHOLOGICAL EXAMINER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIDGES
Authorized Official - Middle Name:WADE
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:III
Authorized Official - Credentials:MS, LSPE
Authorized Official - Phone:423-990-2315
Mailing Address - Street 1:1241 VOLUNTEER PKWY
Mailing Address - Street 2:STE 436
Mailing Address - City:BRISTOL
Mailing Address - State:TN
Mailing Address - Zip Code:37620-4659
Mailing Address - Country:US
Mailing Address - Phone:423-990-2315
Mailing Address - Fax:423-990-2316
Practice Address - Street 1:1241 VOLUNTEER PKWY
Practice Address - Street 2:STE 436
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620-4659
Practice Address - Country:US
Practice Address - Phone:423-990-2315
Practice Address - Fax:423-990-2316
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-12
Last Update Date:2014-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN11716261QM0850X, 261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health