Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 7495 | TN |
Y | 213EG0000X | General Practice | 7495 | TN |
NPI | 1003897281 |
---|---|
Provider Name | Dr. John Alan Smith |
First Address | Kingsport, TN 37664-2535 |
Second Address | Kingsport, TN 37664-2535 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/11/2005 |
Last Update Date | 08/07/2007 |