Provider Demographics
NPI:1730564089
Name:SMITH, TIMOTHY (DC)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:
Last Name:SMITH
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 BUFORD VILLAGE WAY
Mailing Address - Street 2:STE 127
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30518-8845
Mailing Address - Country:US
Mailing Address - Phone:404-889-5050
Mailing Address - Fax:
Practice Address - Street 1:11 BUFORD VILLAGE WAY
Practice Address - Street 2:STE 127
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30518-8845
Practice Address - Country:US
Practice Address - Phone:404-889-5050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-28
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR009520111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor