Provider Demographics
NPI:1922218718
Name:SMITH, ROY FORRESTER (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROY
Middle Name:FORRESTER
Last Name:SMITH
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ONE NORTHGATE PARK
Mailing Address - Street 2:SUITE 308
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37415-6908
Mailing Address - Country:US
Mailing Address - Phone:423-876-7300
Mailing Address - Fax:423-876-1444
Practice Address - Street 1:ONE NORTHGATE PARK
Practice Address - Street 2:SUITE 308
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37415-6908
Practice Address - Country:US
Practice Address - Phone:423-876-7300
Practice Address - Fax:423-876-1444
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNP508103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN38566OtherBCBS