Provider Demographics
NPI:1205898137
Name:SMITH, KEVIN (MD)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:
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 1:281 N LYERLY ST STE 200
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37404-2728
Mailing Address - Country:US
Mailing Address - Phone:423-688-0850
Mailing Address - Fax:423-698-0511
Practice Address - Street 1:281 N LYERLY ST STE 200
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404-2728
Practice Address - Country:US
Practice Address - Phone:423-688-0850
Practice Address - Fax:423-698-0511
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO37926207L00000X
TN61375207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ06091Medicaid
CO99578531Medicaid
COCOA108957Medicare PIN