Provider Demographics
NPI:1548467376
Name:SMITH, ADAM G (MD)
Entity type:Individual
Prefix:DR
First Name:ADAM
Middle Name:G
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 5083
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38101
Mailing Address - Country:US
Mailing Address - Phone:901-747-1000
Mailing Address - Fax:901-747-1001
Practice Address - Street 1:7600 WOLF RIVER BLVD
Practice Address - Street 2:STE 200
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138
Practice Address - Country:US
Practice Address - Phone:901-747-1000
Practice Address - Fax:901-747-1001
Is Sole Proprietor?:No
Enumeration Date:2007-06-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY434582085R0202X
TN557122085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100121600Medicaid
KY7100121600Medicaid