Healthcare Provider Details

I. General information

NPI: 1265926257
Provider Name (Legal Business Name): MICHAEL SMITH DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2018
Last Update Date: 10/14/2024
Certification Date: 10/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 PEACHTREE RD NW
ATLANTA GA
30309-1426
US

IV. Provider business mailing address

4725 N FEDERAL HWY
FORT LAUDERDALE FL
33308-4603
US

V. Phone/Fax

Practice location:
  • Phone: 404-350-7353
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number91408
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: