Provider Demographics
NPI:1215223292
Name:SMITH, COLIN GARRETT (DO)
Entity Type:Individual
Prefix:DR
First Name:COLIN
Middle Name:GARRETT
Last Name:SMITH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 N WASHINGTON AVE
Mailing Address - Street 2:SUITE 265
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501-2603
Mailing Address - Country:US
Mailing Address - Phone:931-854-9432
Mailing Address - Fax:931-854-9434
Practice Address - Street 1:315 N WASHINGTON AVE
Practice Address - Street 2:SUITE 265
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-2603
Practice Address - Country:US
Practice Address - Phone:931-854-9432
Practice Address - Fax:931-854-9434
Is Sole Proprietor?:No
Enumeration Date:2011-06-28
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2681207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ008039Medicaid
TN103I088471Medicare UPIN