Provider Demographics
NPI:1659575181
Name:BOWDOIN G. SMITH D.O.,P.C.
Entity Type:Organization
Organization Name:BOWDOIN G. SMITH D.O.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BOWDOIN
Authorized Official - Middle Name:GRAYSON
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:615-735-0202
Mailing Address - Street 1:9 MAGGART CIR
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:TN
Mailing Address - Zip Code:37030-2151
Mailing Address - Country:US
Mailing Address - Phone:615-735-0202
Mailing Address - Fax:615-735-3011
Practice Address - Street 1:9 MAGGART CIR
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:TN
Practice Address - Zip Code:37030-2151
Practice Address - Country:US
Practice Address - Phone:615-735-0202
Practice Address - Fax:615-735-3011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-11
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDO741207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNF03086OtherPHYSICIAN UPIN
TN3280513Medicaid
TN1346345154OtherINDIVIDUAL NPI
TNF03086OtherPHYSICIAN UPIN