Healthcare Provider Details

I. General information

NPI: 1740382894
Provider Name (Legal Business Name): TAMMY G SMITH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 07/22/2024
Certification Date: 07/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2610 HWY 129 N
JEFFERSON GA
30549
US

IV. Provider business mailing address

2610 HIGHWAY 129 N
JEFFERSON GA
30549-2652
US

V. Phone/Fax

Practice location:
  • Phone: 706-367-1010
  • Fax: 706-367-1050
Mailing address:
  • Phone: 706-367-1010
  • Fax: 706-367-1050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number038372
License Number StateGA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier000608253H
Identifier TypeMEDICAID
Identifier StateGA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: