Provider Demographics
NPI:1639177967
Name:SMITH, GEORGE EDWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:EDWARD
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 OAK RIDGE TPKE
Mailing Address - Street 2:SUITE A-200
Mailing Address - City:OAK RIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37830-6957
Mailing Address - Country:US
Mailing Address - Phone:865-483-2299
Mailing Address - Fax:865-483-0707
Practice Address - Street 1:800 OAK RIDGE TPKE
Practice Address - Street 2:SUITE A-200
Practice Address - City:OAK RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37830-6957
Practice Address - Country:US
Practice Address - Phone:865-483-2299
Practice Address - Fax:865-483-0707
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-11
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD18955208200000X, 2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN5074002OtherAETNA PROVIDER #
TN3093110Medicaid
TNTN010OtherJOHN DEERE PROV #
TN3019173OtherBCBS PROVIDER #
TN5074002OtherAETNA PROVIDER #
TN3093110Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER