Provider Demographics
NPI:1740420702
Name:SMOKY MOUNTAIN MEDICAL ASSOCIATES, P.A.
Entity Type:Organization
Organization Name:SMOKY MOUNTAIN MEDICAL ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATION
Authorized Official - Prefix:MRS
Authorized Official - First Name:WANDA
Authorized Official - Middle Name:N
Authorized Official - Last Name:MEDFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-369-4257
Mailing Address - Street 1:1021 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:NC
Mailing Address - Zip Code:28734-3555
Mailing Address - Country:US
Mailing Address - Phone:828-369-4257
Mailing Address - Fax:828-349-6603
Practice Address - Street 1:1021 RIVER RD
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:NC
Practice Address - Zip Code:28734-3555
Practice Address - Country:US
Practice Address - Phone:828-369-4257
Practice Address - Fax:828-349-6603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-03
Last Update Date:2009-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty