Healthcare Provider Details

I. General information

NPI: 1750374971
Provider Name (Legal Business Name): ROBERT LYNWOOD SMITH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2005
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 DOCTOR'S DRIVE SUITE 201
DOUGLAS GA
31533-2210
US

IV. Provider business mailing address

1100 WARD STREET EXT W
DOUGLAS GA
31533-1902
US

V. Phone/Fax

Practice location:
  • Phone: 912-383-7976
  • Fax: 912-383-7974
Mailing address:
  • Phone: 912-384-1477
  • Fax: 912-384-1470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number31837
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: