Provider Demographics
NPI:1851654263
Name:SMITH, JASON GREGORY (MD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:GREGORY
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:975 E 3RD ST # 376
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37403-2147
Mailing Address - Country:US
Mailing Address - Phone:423-778-7234
Mailing Address - Fax:423-778-6811
Practice Address - Street 1:975 E 3RD ST # 376
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37403
Practice Address - Country:US
Practice Address - Phone:423-778-7234
Practice Address - Fax:423-778-6811
Is Sole Proprietor?:No
Enumeration Date:2012-06-20
Last Update Date:2018-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD607733802085R0202X
TXQ79672085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology