Healthcare Provider Details

I. General information

NPI: 1265491294
Provider Name (Legal Business Name): DANIEL J SMITH NP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2006
Last Update Date: 07/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

747 S HILL ST
GRIFFIN GA
30224-4830
US

IV. Provider business mailing address

592 WATSON RD
FORSYTH GA
31029-3503
US

V. Phone/Fax

Practice location:
  • Phone: 770-228-5407
  • Fax: 770-227-1430
Mailing address:
  • Phone: 770-714-6056
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License NumberRN113417
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN113417
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: