Provider Demographics
NPI:1205153244
Name:SMITH, ANDREW TAYLOR JR
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:TAYLOR
Last Name:SMITH
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:999 HARBOR CLUB CIR E
Mailing Address - Street 2:APT. 101 BLDG. 22
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38103-8813
Mailing Address - Country:US
Mailing Address - Phone:843-303-0518
Mailing Address - Fax:
Practice Address - Street 1:999 HARBOR CLUB CIR E
Practice Address - Street 2:APT. 101 BLDG. 22
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38103-8813
Practice Address - Country:US
Practice Address - Phone:843-303-0518
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-30
Last Update Date:2010-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program