Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0000X | Internist - Cardiovascular Disease | 38966 | GA |
Y | 207RC0001X | Clinical Cardiac Electrophysiologist | 038966 | GA |
NPI | 1013924828 |
---|---|
Provider Name | Dr. Bobby Anthony Smith |
First Address | Atlanta, GA 30309-1709 |
Second Address | Atlanta, GA 30309-1709 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/08/2006 |
Last Update Date | 14/09/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000622872IJKLMNOPQRS | (05) | GA |
E07378 | (02) | GA |