Healthcare Provider Details

I. General information

NPI: 1386943793
Provider Name (Legal Business Name): TREVOR CRAIG SMITH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2011
Last Update Date: 06/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8954 HOSPITAL DR
DOUGLASVILLE GA
30134-2272
US

IV. Provider business mailing address

5665 NEW NORTHSIDE DR STE 320
ATLANTA GA
30328-5834
US

V. Phone/Fax

Practice location:
  • Phone: 770-949-1500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number072130
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: