Healthcare Provider Details

I. General information

NPI: 1205290277
Provider Name (Legal Business Name): MATTHEW TERRENCE SMITH JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2016
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 JESSE HILL JR DR SE FL 5
ATLANTA GA
30303-3050
US

IV. Provider business mailing address

80 JESSE HILL JR DR SE FL 5
ATLANTA GA
30303-3050
US

V. Phone/Fax

Practice location:
  • Phone: 404-616-4466
  • Fax: 404-489-6510
Mailing address:
  • Phone: 404-616-4466
  • Fax: 404-489-6510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number310998
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberMD-55986
License Number StateIA
# 3
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number35.150572
License Number StateOH
# 4
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number110433
License Number StateGA
# 5
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number81928
License Number StateMN
# 6
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberV0179
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: