Basic Information
| Provider Information | |||||||||
| NPI: | 1073779930 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SMITH | ||||||||
| FirstName: | DUSTIN | ||||||||
| MiddleName: | WELLES | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4601 CAROTHERS PKWY | ||||||||
| Address2: | SUITE 360 | ||||||||
| City: | FRANKLIN | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370675976 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6157948900 | ||||||||
| FaxNumber: | 6157940038 | ||||||||
| Practice Location | |||||||||
| Address1: | 4601 CAROTHERS PKWY | ||||||||
| Address2: | SUITE 360 | ||||||||
| City: | FRANKLIN | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370675976 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6157948900 | ||||||||
| FaxNumber: | 6157940038 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/31/2008 | ||||||||
| LastUpdateDate: | 01/08/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 45112 | TN | Y | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.