Healthcare Provider Details

I. General information

NPI: 1174985196
Provider Name (Legal Business Name): CHRISTOPHER GORDON SMITH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2016
Last Update Date: 04/18/2025
Certification Date: 04/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

677 CHURCH ST NE
MARIETTA GA
30060-1101
US

IV. Provider business mailing address

677 CHURCH ST NE
MARIETTA GA
30060-1101
US

V. Phone/Fax

Practice location:
  • Phone: 770-793-5913
  • Fax: 770-999-2445
Mailing address:
  • Phone: 770-793-5913
  • Fax: 770-999-2445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberR4176
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number85621
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: