Provider Demographics
NPI:1962831396
Name:SMITH, GORDON (DPH)
Entity Type:Individual
Prefix:
First Name:GORDON
Middle Name:
Last Name:SMITH
Suffix:
Gender:M
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1008 CENTER POINT PL
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37064-5500
Mailing Address - Country:US
Mailing Address - Phone:615-595-1821
Mailing Address - Fax:615-595-6294
Practice Address - Street 1:1008 CENTER POINT PL
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37064-5500
Practice Address - Country:US
Practice Address - Phone:615-595-1821
Practice Address - Fax:615-595-6294
Is Sole Proprietor?:No
Enumeration Date:2013-11-06
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5328183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist