Healthcare Provider Details

I. General information

NPI: 1386648079
Provider Name (Legal Business Name): THOMAS HARDING SMITH III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2005
Last Update Date: 09/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2260 WRIGHTSBORO RD
AUGUSTA GA
30904-4764
US

IV. Provider business mailing address

PO BOX 933049
ATLANTA GA
31193-3049
US

V. Phone/Fax

Practice location:
  • Phone: 866-313-5266
  • Fax: 205-313-5298
Mailing address:
  • Phone: 866-313-5266
  • Fax: 205-313-5298

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number040793
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: