MEDICARE: DR. DAVID J SMITH DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	033707	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	10044965	OTHER	GA	AMERIGROUP
3	002406	OTHER	GA	BCBS
4	333416	OTHER	GA	WELLCARE OF GEORGIA
5	10650	OTHER	GA	KAISER
6	003406	OTHER	GA	BCBS

General Provider Information

NPI Number	:	1174597439
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID J SMITH DO

Provider Business Mailing Address
First Line	:	13081 HIGHWAY 9 N
Second Line	:
City	:	MILTON
State	:	GA
Zip	:	30004-5150
Country	:	US
Telephone Number	:	770-521-7790
Fax Number	:	770-521-6609

Provider Business Practice Location Address
First Line	:	13081 HIGHWAY 9 N
Second Line	:
City	:	MILTON
State	:	GA
Zip	:	30004-5150
Country	:	US
Telephone Number	:	770-521-7790
Fax Number	:	770-521-6609

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/14/2006
Last Update Date	:	12/01/2010

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Directions to “ DR. DAVID J SMITH DO” Practice Location

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