Provider Demographics
NPI:1346345154
Name:SMITH, BOWDOIN GRAYSON (DO)
Entity Type:Individual
Prefix:DR
First Name:BOWDOIN
Middle Name:GRAYSON
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 1:9 MAGGART CIR
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:TN
Mailing Address - Zip Code:37030-2151
Mailing Address - Country:US
Mailing Address - Phone:615-735-0202
Mailing Address - Fax:615-735-3011
Practice Address - Street 1:9 MAGGART CIR
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:TN
Practice Address - Zip Code:37030-2151
Practice Address - Country:US
Practice Address - Phone:615-735-0202
Practice Address - Fax:615-735-3011
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDO741207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3373462Medicaid
TNDO741OtherSTATE LICENSE NUMBER
TNF03086OtherUPIN
TNF03086OtherUPIN
TN3373462Medicaid