Provider Demographics
NPI:1487611141
Name:SMOTHERS, CHANDREA D (MD)
Entity type:Individual
Prefix:DR
First Name:CHANDREA
Middle Name:D
Last Name:SMOTHERS
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:850 POPLAR AVE
Mailing Address - Street 2:BLDG 2
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38105-4607
Mailing Address - Country:US
Mailing Address - Phone:901-287-8693
Mailing Address - Fax:901-287-6804
Practice Address - Street 1:1910 NONCONNAH BLVD
Practice Address - Street 2:SUITE 120
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38132-2113
Practice Address - Country:US
Practice Address - Phone:901-448-2300
Practice Address - Fax:901-448-6657
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-27
Last Update Date:2020-06-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TN295242085P0229X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085P0229XAllopathic & Osteopathic PhysiciansRadiologyPediatric Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3331644Medicaid
I33123Medicare UPIN
TN3331644Medicaid