Provider Demographics
NPI:1922469873
Name:SMITH, JULIA DENISE (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:DENISE
Last Name:SMITH
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5406 VILLAGE GARDEN DR
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-9007
Mailing Address - Country:US
Mailing Address - Phone:423-238-9800
Mailing Address - Fax:
Practice Address - Street 1:730 E 11TH ST
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37403-3103
Practice Address - Country:US
Practice Address - Phone:423-265-5708
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-18
Last Update Date:2016-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN0000124813163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator