Provider Demographics
NPI:1790753259
Name:SMITH, GINGER L (DO)
Entity Type:Individual
Prefix:DR
First Name:GINGER
Middle Name:L
Last Name:SMITH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:21 DIXON SPRINGS HWY
Mailing Address - Street 2:SUITE D
Mailing Address - City:CARTHAGE
Mailing Address - State:TN
Mailing Address - Zip Code:37030-4011
Mailing Address - Country:US
Mailing Address - Phone:615-735-3555
Mailing Address - Fax:615-735-3588
Practice Address - Street 1:21 DIXON SPRINGS HWY
Practice Address - Street 2:SUITE D
Practice Address - City:CARTHAGE
Practice Address - State:TN
Practice Address - Zip Code:37030-4011
Practice Address - Country:US
Practice Address - Phone:615-735-3555
Practice Address - Fax:615-735-3588
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-10
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN742207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3302044Medicaid
TNE93550Medicare UPIN
TN3302044Medicaid