Provider Demographics
NPI:1649238791
Name:SMOAK, GUY LYNWOOD IV (MD)
Entity type:Individual
Prefix:
First Name:GUY
Middle Name:LYNWOOD
Last Name:SMOAK
Suffix:IV
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 1:1 BETHEL VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:OAK RIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37830-8050
Mailing Address - Country:US
Mailing Address - Phone:865-574-9355
Mailing Address - Fax:865-574-9353
Practice Address - Street 1:1 BETHEL VALLEY RD
Practice Address - Street 2:
Practice Address - City:OAK RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37830-8050
Practice Address - Country:US
Practice Address - Phone:865-574-9355
Practice Address - Fax:865-574-9353
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN18263207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4104246OtherBLUE CROSS/BLUE SHIELD
TN3030905Medicaid
TN3030906Medicaid
TNQ004773Medicaid
TNP00236241OtherRAILROAD MEDICARE
TN3030906Medicaid
TN103I085070Medicare PIN