Provider Demographics
NPI:1003827205
Name:SMITH, WHITAKER MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:WHITAKER
Middle Name:MICHAEL
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:366 MEADOWLAKE CIR
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR
Mailing Address - State:TN
Mailing Address - Zip Code:37865-4971
Mailing Address - Country:US
Mailing Address - Phone:423-335-3323
Mailing Address - Fax:
Practice Address - Street 1:366 MEADOWLAKE CIR
Practice Address - Street 2:
Practice Address - City:SEYMOUR
Practice Address - State:TN
Practice Address - Zip Code:37865-4971
Practice Address - Country:US
Practice Address - Phone:423-335-3323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11537017207Q00000X
VA0101261890207Q00000X
TN0000031792207Q00000X
WA61023437207Q00000X
IL27188207Q00000X
NY305209207Q00000X
OH35.069231207Q00000X
SC84719207Q00000X
SD11943207Q00000X
FLME144976207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3841375Medicaid
VA005618941Medicaid
TN080162793OtherRAILROAD MEDICARE
TNE39178Medicare UPIN
TN3841375Medicare PIN
TN103I089338Medicare PIN