Basic Information
| Provider Information | |||||||||
| NPI: | 1730328436 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SMITH | ||||||||
| FirstName: | GRACE | ||||||||
| MiddleName: | MARIE | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LMT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1009 MANLEY ST | ||||||||
| Address2: | |||||||||
| City: | PARIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 382424915 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7135841430 | ||||||||
| FaxNumber: | 7315841439 | ||||||||
| Practice Location | |||||||||
| Address1: | 30 E MAIN ST | ||||||||
| Address2: | |||||||||
| City: | CAMDEN | ||||||||
| State: | TN | ||||||||
| PostalCode: | 383201734 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7315841430 | ||||||||
| FaxNumber: | 7315841439 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/19/2009 | ||||||||
| LastUpdateDate: | 02/19/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 172V00000X | 0000006739 | TN | Y | Other Service Providers | Community Health Worker |
No ID Information.