Provider Demographics
NPI:1790211894
Name:SMITH, MEAGAN WHITE
Entity Type:Individual
Prefix:
First Name:MEAGAN
Middle Name:WHITE
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:158 HOSPITAL DR STE 500
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:TN
Mailing Address - Zip Code:37030-1083
Mailing Address - Country:US
Mailing Address - Phone:615-735-1560
Mailing Address - Fax:
Practice Address - Street 1:158 HOSPITAL DR STE 500
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:TN
Practice Address - Zip Code:37030-1083
Practice Address - Country:US
Practice Address - Phone:615-735-1560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-10
Last Update Date:2020-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN61432207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine