Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | DS 7667 | TN |
Y | 213EG0000X | General Practice | DS 7667 | TN |
NPI | 1003933037 |
---|---|
Provider Name | Dr. Kevin Cecil Smith |
First Address | Sparta, TN 38583-2215 |
Second Address | Sparta, TN 38583-2215 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/03/2007 |
Last Update Date | 08/07/2007 |