Provider Demographics
NPI:1174597439
Name:SMITH, DAVID J (DO)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:J
Last Name:SMITH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:13081 HIGHWAY 9 N
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:GA
Mailing Address - Zip Code:30004-5150
Mailing Address - Country:US
Mailing Address - Phone:770-521-7790
Mailing Address - Fax:770-521-6609
Practice Address - Street 1:13081 HIGHWAY 9 N
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:GA
Practice Address - Zip Code:30004-5150
Practice Address - Country:US
Practice Address - Phone:770-521-7790
Practice Address - Fax:770-521-6609
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-14
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA033707207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000440932EMedicaid
GA10044965OtherAMERIGROUP
GA002406OtherBCBS
GA333416OtherWELLCARE OF GEORGIA
GA10650OtherKAISER
GA003406OtherBCBS
GAE64733Medicare UPIN
GA93BBGTLMedicare ID - Type Unspecified
GA003406OtherBCBS
GAP00095948Medicare PIN