Provider Demographics
NPI:1659375228
Name:SMITH, GARY J (MD)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:J
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:7640 HIGHWAY 70 S
Mailing Address - Street 2:STE 201
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37221-1758
Mailing Address - Country:US
Mailing Address - Phone:615-646-8098
Mailing Address - Fax:615-646-8557
Practice Address - Street 1:7640 HIGHWAY 70 S
Practice Address - Street 2:STE 201
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37221-1758
Practice Address - Country:US
Practice Address - Phone:615-646-8098
Practice Address - Fax:615-646-8557
Is Sole Proprietor?:No
Enumeration Date:2005-06-10
Last Update Date:2010-08-03
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Provider Licenses
StateLicense IDTaxonomies
TNMD019182207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TND93150Medicare UPIN