Provider Demographics
NPI:1669543807
Name:SMITH, PAUL GRAYSON III (DO)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:GRAYSON
Last Name:SMITH
Suffix:III
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:525 HUNT CLIFF DR NW
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37311-1642
Mailing Address - Country:US
Mailing Address - Phone:423-903-8339
Mailing Address - Fax:
Practice Address - Street 1:2121 N OCOEE ST
Practice Address - Street 2:SUITE 101
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37311-3953
Practice Address - Country:US
Practice Address - Phone:423-472-6548
Practice Address - Fax:423-472-8318
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDO1806207Q00000X
FLOS9860207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNFP62706OtherWORKERS COMP
TN3719099Medicaid
TNX86491OtherHEALTH SPRING
TN11715949OtherCAQH
TNTN0101OtherJOHN DEERE
TN4155514OtherBCBS OF TN
TNDO1806OtherSTATE LICENSE
TN6635438OtherCIGNA
TNFP62706OtherWORKERS COMP