Doctor Name: | SUSAN J SMITH |
NPI Number: | 1871621474 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MD |
License Number: | 030547-GA |
Business Practice Address: | 852 Dacula Rd Dacula, GA - 300193185 |
Business Phone Number: | 7708489360 |
Business Fax Number: | |
Mailing Address: | Po Box 742616, ATLANTA |
State: | GA |
Postal Code: | 303742616 |
Phone Number: | 7702198420 |
Fax Number: | 7702198440 |
NPI Enumeration Date: | 03/02/2007 |
NPI Last Update Date: | 12/18/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 390200000X |
License Number: | 030547-GA |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | GA |
Taxonomy Type: | Student, Health Care |
Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |