Provider Demographics
NPI:1952472185
Name:PAUL GRAYSON SMITH, JR., D.O., P.C.
Entity Type:Organization
Organization Name:PAUL GRAYSON SMITH, JR., D.O., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:DIGIAMMARINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-472-6548
Mailing Address - Street 1:2121 N OCOEE ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37311-3953
Mailing Address - Country:US
Mailing Address - Phone:423-472-6548
Mailing Address - Fax:423-472-8318
Practice Address - Street 1:2121 N OCOEE ST
Practice Address - Street 2:SUITE 101
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37311-3953
Practice Address - Country:US
Practice Address - Phone:423-472-6548
Practice Address - Fax:423-472-8318
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDO256207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty