Individual
MR. MARK THOMAS SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
106 CREEK ST, LAKE CITY, TN 37769
(865) 426-2186
(865) 426-9200
Mailing address
134 FIELD STONE DR, ANDERSONVILLE, TN 37705-3336
(865) 300-8084
(865) 381-0533
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
1001
TN
Other
Enumeration date
08/23/2007
Last updated
08/23/2007
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