Healthcare Provider Details

I. General information

NPI: 1699352195
Provider Name (Legal Business Name): STEPHEN JAMES SMITH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2021
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 E 15TH ST
ALMA GA
31510-2908
US

IV. Provider business mailing address

204 E 15TH ST
ALMA GA
31510-2908
US

V. Phone/Fax

Practice location:
  • Phone: 912-632-0314
  • Fax: 912-632-2554
Mailing address:
  • Phone: 912-632-0314
  • Fax: 912-632-2554

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number112050
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberLL85906
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: