Mark Thomas Smith, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

1001 Issued in TN

Practice address

106 Creek St
Lake City, TN 37769

Phone

(865) 426-2186

Fax

(865) 426-9200

NPI assigned

Aug 23, 2007

Sex

Male

Sole proprietor

Yes

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Marks Pharmacy

  • Community/Retail Pharmacy
  • Lake City, TN
  • NPI 1285793653
  NPD (past) Authorized official
• Marks Pharmacy

  • Durable Medical Equipment & Medical Supplies
  • Lake City, TN
  • NPI 1467645986
  NPD (past) Authorized official

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Physician Assistant

State licenses

Practice roles

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Aug 23, 2007.

{
    "created_epoch": "1187827200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1187827200000",
    "number": "1235322181",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "134 FIELD STONE DR",
            "city": "ANDERSONVILLE",
            "state": "TN",
            "postal_code": "377053336",
            "telephone_number": "865-300-8084",
            "fax_number": "865-381-0533"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "106 CREEK ST",
            "city": "LAKE CITY",
            "state": "TN",
            "postal_code": "37769",
            "telephone_number": "865-426-2186",
            "fax_number": "865-426-9200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "MARK",
        "middle_name": "THOMAS",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-08-23",
        "last_updated": "2007-08-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "TN",
            "license": "1001",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• David Carl Dew, R.P.H.
• Marks Pharmacy
• Marks Pharmacy
• Wendy Braden Miller, NP-C
• Ronald E. Noe, D.D.S.
• Sheila Marie Sparks, OT
• Summit View of Lake City, LLC
• Michelle Leigh Wyrick, COTA/L

• All providers in Lake City, TN
• Medical Physician Assistant in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.