Healthcare Provider Details

I. General information

NPI: 1679582464
Provider Name (Legal Business Name): WILLIAM SEAN SMITH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 10/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 JOHNSON FERRY ROAD
ATLANTA GA
30342
US

IV. Provider business mailing address

5775 GLENRIDGE DRIVE NE B525
ATLANTA GA
30328
US

V. Phone/Fax

Practice location:
  • Phone: 404-851-6323
  • Fax: 404-303-3747
Mailing address:
  • Phone: 678-553-7783
  • Fax: 678-553-7793

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License NumberME19579
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code2085P0229X
TaxonomyPediatric Radiology Physician
License NumberME19579
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberME19579
License Number StateSC
# 4
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberME19579
License Number StateSC
# 5
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License NumberME19579
License Number StateSC
# 6
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number042731
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: