Provider Demographics
NPI:1649363425
Name:SMITH, RONALD STEVEN (MD)
Entity type:Individual
Prefix:MR
First Name:RONALD
Middle Name:STEVEN
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 1:1920 BROOKSIDE DR
Mailing Address - Street 2:STE 12
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-4613
Mailing Address - Country:US
Mailing Address - Phone:423-392-6521
Mailing Address - Fax:423-392-6511
Practice Address - Street 1:1920 BROOKSIDE DR
Practice Address - Street 2:STE 12
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-4613
Practice Address - Country:US
Practice Address - Phone:423-392-6521
Practice Address - Fax:423-392-6511
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD00000137972084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA069098OtherBCVA
TN0018152OtherBCTN
TN3189819Medicaid
TN3701225Medicare ID - Type Unspecified
B04401Medicare UPIN