Doctor Name: | MR. DONALD RAY SMITH |
NPI Number: | 1235300369 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | CAC-II |
License Number: | 1759 |
Business Practice Address: | 3970 Golden Isle E Baxley, GA - 315137216 |
Business Phone Number: | 9123674614 |
Business Fax Number: | |
Mailing Address: | 3970 Golden Isle E, BAXLEY |
State: | GA |
Postal Code: | 315137216 |
Phone Number: | 9123674614 |
Fax Number: | |
NPI Enumeration Date: | 03/17/2008 |
NPI Last Update Date: | 03/18/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | 1759 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | GA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |