Provider Demographics
NPI:1295955797
Name:SMITH, SARAH GREER (MD)
Entity type:Individual
Prefix:DR
First Name:SARAH
Middle Name:GREER
Last Name:SMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2775 LOMBARDY AVE STE 989
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38111-1921
Mailing Address - Country:US
Mailing Address - Phone:859-457-6865
Mailing Address - Fax:
Practice Address - Street 1:930 MADISON AVE STE 801
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38103-3410
Practice Address - Country:US
Practice Address - Phone:901-866-8605
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007029454207N00000X
KY43673207N00000X
TN55633207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ029595Medicaid
MS08006741Medicaid
AR222780001Medicaid
KYK034600OtherMEDICARE-UNSPECIFIED