Provider Demographics
NPI:1336121318
Name:SMITH, TAMRA L (MD)
Entity Type:Individual
Prefix:DR
First Name:TAMRA
Middle Name:L
Last Name:SMITH
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 1:853 W POPLAR AVE
Mailing Address - Street 2:
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38017-2545
Mailing Address - Country:US
Mailing Address - Phone:901-850-8351
Mailing Address - Fax:901-861-2064
Practice Address - Street 1:853 W POPLAR AVE
Practice Address - Street 2:
Practice Address - City:COLLIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:38017-2545
Practice Address - Country:US
Practice Address - Phone:901-850-8351
Practice Address - Fax:901-861-2064
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-16
Last Update Date:2015-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000027302207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3096572Medicaid
G18083Medicare UPIN