Provider Demographics
NPI:1083458244
Name:SMOTHERMON, EMILY RENEE
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:RENEE
Last Name:SMOTHERMON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3332 TAYLORWOOD LN
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:TN
Mailing Address - Zip Code:37174-7527
Mailing Address - Country:US
Mailing Address - Phone:931-215-4562
Mailing Address - Fax:
Practice Address - Street 1:3332 TAYLORWOOD LN
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:TN
Practice Address - Zip Code:37174-7527
Practice Address - Country:US
Practice Address - Phone:931-215-4562
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-22
Last Update Date:2024-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician