Provider Demographics
NPI:1134233745
Name:SMITH, ERIC L (MD)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:L
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 1:3173 KIRBY WHITTEN RD STE 104
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:TN
Mailing Address - Zip Code:38134-2881
Mailing Address - Country:US
Mailing Address - Phone:901-384-8040
Mailing Address - Fax:901-888-4748
Practice Address - Street 1:3173 KIRBY WHITTEN RD STE 104
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38134-2881
Practice Address - Country:US
Practice Address - Phone:901-737-1992
Practice Address - Fax:901-309-8784
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0320432084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3854263Medicaid
TN3854263Medicaid
H12610Medicare UPIN