Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 10003 | GA |
NPI | 1578555157 |
---|---|
Provider Name | Dr. Debra Bradfield Smith |
First Address | Eastman, GA 31023-5560 |
Second Address | Eastman, GA 31023-6761 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00297932A | (05) | GA |
00297932B | (05) | GA |