MEDICARE: ROBERT WHITTHORN SMITH JR. MD

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	207Q00000X	Family Medicine Physician	040795	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	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1396730222
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT WHITTHORN SMITH JR. MD

Provider Business Mailing Address
First Line	:	221 TECHNOLOGY PKWY NW
Second Line	:
City	:	ROME
State	:	GA
Zip	:	30165-1369
Country	:	US
Telephone Number	:	762-235-1000
Fax Number	:

Provider Business Practice Location Address
First Line	:	5470 MARTHA BERRY HWY NE
Second Line	:
City	:	ARMUCHEE
State	:	GA
Zip	:	30105-2302
Country	:	US
Telephone Number	:	706-235-1156
Fax Number	:	706-291-9391

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

Provider Enumeration Date	:	09/16/2005
Last Update Date	:	05/05/2020

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