Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RR0500X | Rheumatology | 045973 | GA |
NPI | 1053303685 |
---|---|
Provider Name | Dr. Michael Lance Smitherman |
First Address | Roswell, GA 30076-3810 |
Second Address | Roswell, GA 30076-3810 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/08/2005 |
Last Update Date | 12/01/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0008094650 | (05) | GA |
045973 | LICENSE (01) | GA |
G98425 | (02) |