Individual
KENNETH WAYNE SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2 SHERIDAN SQ, SUITE 200, KINGSPORT, TN 37660-7399
(423) 246-8061
(423) 243-8278
Mailing address
2 SHERIDAN SQ STE 200, KINGSPORT, TN 37660-7399
(423) 246-8061
(423) 243-8278
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
MD020006
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3047670
—
TN
Enumeration date
08/16/2005
Last updated
10/22/2020
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