Provider Demographics
NPI:1669780961
Name:SMITH, ANGELA D (CFOM, CFTS)
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:D
Last Name:SMITH
Suffix:
Gender:F
Credentials:CFOM, CFTS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1334 MACKEY BRANCH DR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-3471
Mailing Address - Country:US
Mailing Address - Phone:423-296-2604
Mailing Address - Fax:423-296-2607
Practice Address - Street 1:1334 MACKEY BRANCH DR
Practice Address - Street 2:SUITE 104
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-3471
Practice Address - Country:US
Practice Address - Phone:423-296-2604
Practice Address - Fax:423-296-2607
Is Sole Proprietor?:No
Enumeration Date:2010-09-21
Last Update Date:2016-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1455062Medicaid