Healthcare Provider Details

I. General information

NPI: 1366553901
Provider Name (Legal Business Name): TANIA SMITH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 02/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 POINTE NORTH BLVD
ALBANY GA
31721-1513
US

IV. Provider business mailing address

600 POINTE NORTH BLVD
ALBANY GA
31721-1513
US

V. Phone/Fax

Practice location:
  • Phone: 229-903-4044
  • Fax: 229-903-4055
Mailing address:
  • Phone: 229-903-4044
  • Fax: 229-903-4055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number051602
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: