Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207U00000X | Nuclear Medicine Specialist | TL34514 | SC |
NPI | 1508064890 |
---|---|
Provider Name | Marvin Montgomery Smith |
First Address | Indianapolis, IN 46206-3239 |
Second Address | Columbia, TN 38401-4802 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2007 |
Last Update Date | 04/08/2021 |