Provider Demographics
NPI:1225132897
Name:SMITH, MICHAEL HALL (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:HALL
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37403-1503
Mailing Address - Country:US
Mailing Address - Phone:423-756-4796
Mailing Address - Fax:423-267-7117
Practice Address - Street 1:102 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37403-1503
Practice Address - Country:US
Practice Address - Phone:423-756-4796
Practice Address - Fax:423-267-7117
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN29664207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000824238DMedicaid
TN3819869Medicaid
TNG62097Medicare UPIN
GA000824238DMedicaid