Provider Demographics
NPI:1184880338
Name:WENDY L SMITH M.D. PC
Entity type:Organization
Organization Name:WENDY L SMITH M.D. PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-745-1305
Mailing Address - Street 1:130 HOSPITAL CIR
Mailing Address - Street 2:
Mailing Address - City:BLAIRSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30512-3130
Mailing Address - Country:US
Mailing Address - Phone:706-745-1305
Mailing Address - Fax:706-745-8463
Practice Address - Street 1:130 HOSPITAL CIR
Practice Address - Street 2:
Practice Address - City:BLAIRSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30512-3130
Practice Address - Country:US
Practice Address - Phone:706-745-1305
Practice Address - Fax:706-745-8463
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-06
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAUD003556231H00000X
GA049746207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000913756CMedicaid
NC89065FTMedicaid
GA000913756CMedicaid