Healthcare Provider Details

I. General information

NPI: 1255369732
Provider Name (Legal Business Name): STEPHANIE J SMITH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 09/02/2020
Certification Date: 09/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 JESSE JEWELL PKWY SE STE 200
GAINESVILLE GA
30501-3865
US

IV. Provider business mailing address

PO BOX 551420
FORT LAUDERDALE FL
33355-1420
US

V. Phone/Fax

Practice location:
  • Phone: 770-297-7277
  • Fax:
Mailing address:
  • Phone: 800-243-3839
  • Fax: 954-839-2569

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number039472
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: