Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QA0505X | Family Doctor - Adult Medicine | 23602 | TN |
N | 208D00000X | General Practice Physician | 23602 | TN |
NPI | 1336655745 |
---|---|
Provider Name | Lori Smith |
First Address | Carthage, MS 39051-7213 |
Second Address | Memphis, TN 38119-5214 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/12/2017 |
Last Update Date | 20/12/2017 |