Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | 038615 | GA |
N | 207N00000X | Dermatologist | 17623 | SC |
Y | 207ND0101X | MOHS-Micrographic Surgeon | 038615 | GA |
N | 207ND0900X | Dermatopathologist | 038615 | GA |
N | 207ND0900X | Dermatopathologist | 17623 | SC |
N | 207NP0225X | Pediatric Dermatologist | 038615 | GA |
N | 207NP0225X | Pediatric Dermatologist | 17623 | SC |
N | 207NS0135X | Procedural Dermatology | 038615 | GA |
N | 207NS0135X | Procedural Dermatology | 17623 | SC |
N | 207Q00000X | Family Doctor | 38615 | GA |
N | 207R00000X | Internist | 038615 | GA |
N | 111NI0900X | Internist | 038615 | GA |
NPI | 1104817410 |
---|---|
Provider Name | Mr. Sidney P Smith |
First Address | Savannah, GA 31419-1780 |
Second Address | Savannah, GA 31419-1780 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/11/2005 |
Last Update Date | 31/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000637909C | (05) | GA |
176231 | (05) | SC |
722272524A | (05) | GA |
722272524B | (05) | GA |
722272524C | (05) | GA |
E68293 | (02) | GA |