Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | TN | |
N | 222Z00000X | Podiatrist | TN | |
Y | 224P00000X | Prosthetist |
NPI | 1295233369 |
---|---|
Provider Name | Christian Zach Smith |
First Address | Johnson City, TN 37604-2007 |
Second Address | Johnson City, TN 37604-2007 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/01/2018 |
Last Update Date | 17/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1454184 | (05) | TN |
1457443624 | (05) | NC |