Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251E1300X | Electrophysiology, Clinical | PT000819 | GA |
NPI | 1487824918 |
---|---|
Provider Name | Mr. Dannie Carroll Smith |
First Address | Thomaston, GA 30286-4911 |
Second Address | Thomaston, GA 30286-4911 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/03/2008 |
Last Update Date | 12/03/2008 |