Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RH0002X | Hospice and Palliative Medicine | 83486 | GA |
NPI | 1205222189 |
---|---|
Provider Name | Kevin Deshaun Smith |
First Address | Austell, GA 30106-1121 |
Second Address | Austell, GA 30106 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/04/2015 |
Last Update Date | 15/10/2019 |