Healthcare Provider Details

I. General information

NPI: 1336244615
Provider Name (Legal Business Name): MICHAEL GARY BYAS-SMITH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1364 CLIFTON RD NE EUH, DEPARTMENT OF ANESTHESIOLOGY, SUITE A305
ATLANTA GA
30322-1059
US

IV. Provider business mailing address

1364 CLIFTON ROAD EUH, DEPARTMENT OF ANESTHESIOLOGY, SUITE A305
ATLANTA GA
30022
US

V. Phone/Fax

Practice location:
  • Phone: 404-778-3900
  • Fax: 404-778-1205
Mailing address:
  • Phone: 404-778-3900
  • Fax: 404-778-1205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number31715
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: