Provider Demographics
NPI:1518937572
Name:SMITH, KIMBERLY KAY (MD)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:KAY
Last Name:SMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:KAY
Other - Last Name:EDWARDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:975 E. THIRD STREET
Mailing Address - Street 2:ATTN: PROVIDER ENROLLMENT
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37403
Mailing Address - Country:US
Mailing Address - Phone:423-778-9001
Mailing Address - Fax:423-778-9014
Practice Address - Street 1:979 E. THIRD STREET
Practice Address - Street 2:SUITE# C-830
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37403
Practice Address - Country:US
Practice Address - Phone:423-778-9001
Practice Address - Fax:423-778-9014
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2018-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0373842084N0400X
TN565672084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA01946877OtherAMERIGROUP
GA928906OtherWELLCARE
GA000557807EMedicaid
GAP01332066OtherRR MEDICARE
GA928906OtherWELLCARE
GA202I136285Medicare PIN