Healthcare Provider Details

I. General information

NPI: 1083678817
Provider Name (Legal Business Name): SPENCER REID SMITH RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2006
Last Update Date: 10/04/2022
Certification Date: 10/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 E LAMAR ST STE B
AMERICUS GA
31709-3744
US

IV. Provider business mailing address

116 N VALHALLA CT
CORDELE GA
31015-9308
US

V. Phone/Fax

Practice location:
  • Phone: 229-928-9010
  • Fax: 229-928-4477
Mailing address:
  • Phone: 229-273-7513
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number017305
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: