Provider Demographics
NPI:1619794005
Name:SMITH, MADISON D (MA)
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:D
Last Name:SMITH
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 LEE ST APT 1
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-6191
Mailing Address - Country:US
Mailing Address - Phone:606-226-6398
Mailing Address - Fax:
Practice Address - Street 1:114 W JACKSON BLVD
Practice Address - Street 2:
Practice Address - City:JONESBOROUGH
Practice Address - State:TN
Practice Address - Zip Code:37659-1224
Practice Address - Country:US
Practice Address - Phone:423-753-1701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-25
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program