Provider Demographics
NPI:1881862050
Name:SMITH, BRANDON JOSHUA (LAC)
Entity Type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:JOSHUA
Last Name:SMITH
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:560 FIRE STATION RD
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-4016
Mailing Address - Country:US
Mailing Address - Phone:931-358-4146
Mailing Address - Fax:931-358-4147
Practice Address - Street 1:560 FIRE STATION RD
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-4016
Practice Address - Country:US
Practice Address - Phone:931-358-4146
Practice Address - Fax:931-358-4147
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-11
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN77171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist