Healthcare Provider Details

I. General information

NPI: 1407858475
Provider Name (Legal Business Name): STEPHEN W SMITH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 08/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 PEACHTREE RD NE SUITE 705
ATLANTA GA
30309-1476
US

IV. Provider business mailing address

2001 PEACHTREE RD NE SUITE 705
ATLANTA GA
30309-1476
US

V. Phone/Fax

Practice location:
  • Phone: 404-355-0743
  • Fax: 404-355-2136
Mailing address:
  • Phone: 404-355-0743
  • Fax: 404-355-2136

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number042442
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License Number042442
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: