Provider Demographics
NPI:1750374971
Name:SMITH, ROBERT LYNWOOD (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:LYNWOOD
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1100 WARD STREET EXT W
Mailing Address - Street 2:
Mailing Address - City:DOUGLAS
Mailing Address - State:GA
Mailing Address - Zip Code:31533-1902
Mailing Address - Country:US
Mailing Address - Phone:912-384-1477
Mailing Address - Fax:912-384-1470
Practice Address - Street 1:100 DOCTOR'S DRIVE
Practice Address - Street 2:SUITE 201
Practice Address - City:DOUGLAS
Practice Address - State:GA
Practice Address - Zip Code:31533-2210
Practice Address - Country:US
Practice Address - Phone:912-383-7976
Practice Address - Fax:912-383-7974
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA31837207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA031837OtherPHYSICIAN LICENSE
GA455142019DMedicaid
GA11D1105865OtherCLIA ID - 17 JOHNSON ST
GA455142019CMedicaid
GA11D1089117OtherCLIA ID - 100 DOCTORS DR STE 201
GA341265OtherWELLCARE
GAGRP7930OtherCAHABA MEDICARE GROUP #
GADH1281OtherMEDICARE RAILROAD - GROUP #
GAP00726007OtherMEDICARE RAILROAD - PTAN
GAP00726007OtherMEDICARE RAILROAD - PTAN
GADH1281OtherMEDICARE RAILROAD - GROUP #
B10204Medicare UPIN