Individual
RAYMOND SHANE SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
410 N STATE OF FRANKLIN RD, SUITE 130, JOHNSON CITY, TN 37604-6971
(423) 431-2477
(423) 431-2478
Mailing address
410 N STATE OF FRANKLIN RD, SUITE 130, JOHNSON CITY, TN 37604-6971
(423) 431-2477
(423) 431-2478
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2338
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1104006592
—
NC
05
—
1104006592
—
VA
05
—
Q002626
—
TN
Enumeration date
11/14/2007
Last updated
02/23/2017
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