Provider Demographics
NPI:1730328436
Name:SMITH, GRACE MARIE (LMT)
Entity type:Individual
Prefix:MS
First Name:GRACE
Middle Name:MARIE
Last Name:SMITH
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1009 MANLEY ST
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:TN
Mailing Address - Zip Code:38242-4915
Mailing Address - Country:US
Mailing Address - Phone:713-584-1430
Mailing Address - Fax:731-584-1439
Practice Address - Street 1:30 E MAIN ST
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:TN
Practice Address - Zip Code:38320-1734
Practice Address - Country:US
Practice Address - Phone:731-584-1430
Practice Address - Fax:731-584-1439
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-19
Last Update Date:2009-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000006739172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker