Provider Demographics
NPI:1790039188
Name:SMITH, JEREMIAH SHANE (NP)
Entity Type:Individual
Prefix:MR
First Name:JEREMIAH
Middle Name:SHANE
Last Name:SMITH
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Gender:M
Credentials:NP
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Mailing Address - Street 1:1949 GUNBARREL ROAD
Mailing Address - Street 2:SUITE 230
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421
Mailing Address - Country:US
Mailing Address - Phone:423-495-4349
Mailing Address - Fax:423-495-4934
Practice Address - Street 1:605 GLENWOOD DRIVE, SUITE 105
Practice Address - Street 2:CHI MEMORIAL THORACIC ONCOLOGY ASSOCIATES
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404
Practice Address - Country:US
Practice Address - Phone:423-495-5864
Practice Address - Fax:423-495-2065
Is Sole Proprietor?:No
Enumeration Date:2012-11-07
Last Update Date:2022-07-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TNAPN0000016902363LA2100X
TN16902363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN16902OtherAPN LICENSE