Provider Demographics
NPI:1922009521
Name:SMITH, ELIZABETH C (MD)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:C
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 1:1817 MILLBROOK DR
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-1486
Mailing Address - Country:US
Mailing Address - Phone:423-282-5888
Mailing Address - Fax:
Practice Address - Street 1:302 WESLEY ST
Practice Address - Street 2:SUITE 10
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37601-1740
Practice Address - Country:US
Practice Address - Phone:423-928-9007
Practice Address - Fax:423-928-9249
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist