Provider Demographics
NPI:1821041450
Name:SMITH, PAUL S (EDD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:S
Last Name:SMITH
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 CHURCH ST STE 203
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-2286
Mailing Address - Country:US
Mailing Address - Phone:615-329-8900
Mailing Address - Fax:615-369-8711
Practice Address - Street 1:1900 CHURCH ST STE 300
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-2285
Practice Address - Country:US
Practice Address - Phone:615-329-8900
Practice Address - Fax:615-369-8711
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNP1605103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3683987Medicaid
TN3683987Medicare ID - Type Unspecified