Healthcare Provider Details

I. General information

NPI: 1811045362
Provider Name (Legal Business Name): KEVIN MADRAS SMITH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

803 N JEFFERSON ST STE C
ALBANY GA
31701-5117
US

IV. Provider business mailing address

2410 SYLVESTER RD
ALBANY GA
31705-2479
US

V. Phone/Fax

Practice location:
  • Phone: 229-312-5800
  • Fax:
Mailing address:
  • Phone: 229-312-9200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number057272
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: