Provider Demographics
NPI:1740334325
Name:EBY, CYNTHIA SMALLMAN (DPM)
Entity type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:SMALLMAN
Last Name:EBY
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4512 DAYTON BLVD
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37415-2148
Mailing Address - Country:US
Mailing Address - Phone:423-875-2171
Mailing Address - Fax:423-875-6020
Practice Address - Street 1:4512 DAYTON BLVD
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37415-2148
Practice Address - Country:US
Practice Address - Phone:423-875-2171
Practice Address - Fax:423-875-6020
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDPM 239213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1511912Medicaid
TN33510221Medicare PIN
TN1511912Medicaid