Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 036012 | GA |
N | 111NI0900X | Internist | 036012 | GA |
Y | 207RC0000X | Internist - Cardiovascular Disease | 036012 | GA |
NPI | 1023054806 |
---|---|
Provider Name | John Darrell Smith |
First Address | Stockbridge, GA 30281-9084 |
Second Address | Stockbridge, GA 30281-9084 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2006 |
Last Update Date | 25/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00508626B | (05) | GA |
00508626C | (05) | GA |
E06478 | (02) |