Healthcare Provider Details

I. General information

NPI: 1487614574
Provider Name (Legal Business Name): SUZANNE PATRICE SMITH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 05/19/2025
Certification Date: 05/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1293 WELLBROOK CIR NE
CONYERS GA
30012-3873
US

IV. Provider business mailing address

PO BOX 116470
ATLANTA GA
30368-6470
US

V. Phone/Fax

Practice location:
  • Phone: 770-922-2012
  • Fax: 770-922-8370
Mailing address:
  • Phone: 770-682-2080
  • Fax: 678-579-9398

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number48824
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: