Provider Demographics
NPI:1952370587
Name:SMITH, DEVON D (MD)
Entity Type:Individual
Prefix:DR
First Name:DEVON
Middle Name:D
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 1:1621 W MORRIS BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37813-2967
Mailing Address - Country:US
Mailing Address - Phone:432-307-8088
Mailing Address - Fax:423-307-8049
Practice Address - Street 1:1621 W MORRIS BLVD STE A
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37813
Practice Address - Country:US
Practice Address - Phone:432-307-8088
Practice Address - Fax:423-307-8049
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-16
Last Update Date:2018-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN21152207P00000X, 208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN208941765OtherTAX ID
TN3069190Medicaid
TN3370150Medicaid
KY363946OtherANTHEM BCBS
TN100024081OtherPHP TNCARE
KY64920887Medicaid
TN4153913OtherBCBS
TN0116OtherJOHN DEERE INS.
3069190Medicare ID - Type Unspecified
TN208941765OtherTAX ID
KY64920887Medicaid