Provider Demographics
NPI:1629028782
Name:SMITH, CHRISTOPHER L (DO)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:L
Last Name:SMITH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:821 CARTER FARRIS LN
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:TN
Mailing Address - Zip Code:37398-2978
Mailing Address - Country:US
Mailing Address - Phone:931-967-1514
Mailing Address - Fax:931-962-4081
Practice Address - Street 1:2900 16TH ST
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:IN
Practice Address - Zip Code:47421-3510
Practice Address - Country:US
Practice Address - Phone:812-276-4378
Practice Address - Fax:812-275-1299
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1153207P00000X
AL1223207P00000X
TNDO1153207Q00000X, 207R00000X
IN02005853A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3809740Medicaid
TNB42886Medicare UPIN
TN3809472Medicare ID - Type Unspecified