Provider Demographics
NPI:1548431356
Name:SMITH, TATANISHA PATRICE (MD)
Entity Type:Individual
Prefix:DR
First Name:TATANISHA
Middle Name:PATRICE
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 1:393 WALLACE RD STE 202
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37211-4834
Mailing Address - Country:US
Mailing Address - Phone:615-709-2057
Mailing Address - Fax:855-888-1434
Practice Address - Street 1:393 WALLACE RD STE 202
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37211
Practice Address - Country:US
Practice Address - Phone:615-709-2057
Practice Address - Fax:855-888-1434
Is Sole Proprietor?:No
Enumeration Date:2008-03-19
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD433744208000000X
TN50289208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2857154Medicaid
WV3810012511Medicaid
TN50289OtherTN MED LIC
PA1021638590001Medicaid
WV3810012511Medicaid