Provider Demographics
NPI:1861639031
Name:SMITH, REBECCA HELEN (MD)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:HELEN
Last Name:SMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:854 W JAMES CAMPBELL BLVD
Mailing Address - Street 2:SUITE 303
Mailing Address - City:COLUMBIA
Mailing Address - State:TN
Mailing Address - Zip Code:38401-4659
Mailing Address - Country:US
Mailing Address - Phone:931-379-5821
Mailing Address - Fax:931-379-5867
Practice Address - Street 1:200 S CROSS BRIDGES RD
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:TN
Practice Address - Zip Code:38474-1714
Practice Address - Country:US
Practice Address - Phone:931-379-5821
Practice Address - Fax:931-379-5867
Is Sole Proprietor?:No
Enumeration Date:2009-01-09
Last Update Date:2018-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN51818207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3710089Medicaid
3710089Medicare PIN