Provider Demographics
NPI:1215978747
Name:SMITH, PAUL GRAYSON JR (DO)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:GRAYSON
Last Name:SMITH
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:2121 N OCOEE ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37311-3953
Mailing Address - Country:US
Mailing Address - Phone:423-472-6548
Mailing Address - Fax:423-472-8318
Practice Address - Street 1:2121 N OCOEE ST
Practice Address - Street 2:SUITE 101
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37311-3953
Practice Address - Country:US
Practice Address - Phone:423-472-6548
Practice Address - Fax:423-472-8318
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2007-07-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TNDO256207Q00000X
FLOS3710207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0140208OtherUNITED HEALTHCARE
TN3719099Medicaid
TNTN0101OtherJOHN DEERE HEALTH
TNFP62706OtherWORKER'S COMP
TN2000307OtherBCBS OF TN
TN10811010OtherCAQH
TN3719099Medicare ID - Type UnspecifiedCIGNA MEDICARE-INDIVIDUAL
TN2000307OtherBCBS OF TN
TND32224Medicare UPIN