Healthcare Provider Details

I. General information

NPI: 1992138366
Provider Name (Legal Business Name): WILLIAM BENJAMIN SMISSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2013
Last Update Date: 06/05/2024
Certification Date: 06/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1157 FORSYTH ST STE 200
MACON GA
31201-7454
US

IV. Provider business mailing address

4163 CANYON RD
MACON GA
31210-4742
US

V. Phone/Fax

Practice location:
  • Phone: 478-476-1968
  • Fax:
Mailing address:
  • Phone: 478-808-5388
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number77206
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number77206
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: