Provider Demographics
NPI:1306110507
Name:CHARLIE R SMITH OFFICE
Entity type:Organization
Organization Name:CHARLIE R SMITH OFFICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLIE
Authorized Official - Middle Name:R
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-889-5594
Mailing Address - Street 1:2821 LEBANON PIKE
Mailing Address - Street 2:STE 103
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37214-2518
Mailing Address - Country:US
Mailing Address - Phone:615-889-5594
Mailing Address - Fax:615-889-5597
Practice Address - Street 1:2821 LEBANON PIKE
Practice Address - Street 2:STE 103
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37214-2518
Practice Address - Country:US
Practice Address - Phone:615-889-5594
Practice Address - Fax:615-889-5597
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-06
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5420174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
B59241Medicare UPIN
3152830Medicare PIN