Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 075543 | GA |
Y | 111NI0900X | Internist | 075543 | GA |
N | 207RG0100X | Gastroenterologist | 19469 | TN |
NPI | 1023075983 |
---|---|
Provider Name | Dr. James Lacey Smith |
First Address | Columbus, GA 31904-2285 |
Second Address | Columbus, GA 31904 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2006 |
Last Update Date | 31/05/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F09639 | (02) |