Provider Demographics
NPI:1285197426
Name:SMARTT, JACQUELINE R (MD)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:R
Last Name:SMARTT
Suffix:
Gender:F
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:PO BOX 76
Mailing Address - Street 2:
Mailing Address - City:SMARTT
Mailing Address - State:TN
Mailing Address - Zip Code:37378-0076
Mailing Address - Country:US
Mailing Address - Phone:931-607-2623
Mailing Address - Fax:
Practice Address - Street 1:1911 MCARTHUR ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:TN
Practice Address - Zip Code:37355-2688
Practice Address - Country:US
Practice Address - Phone:931-968-3142
Practice Address - Fax:931-683-1489
Is Sole Proprietor?:No
Enumeration Date:2019-04-12
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN65569207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine