Healthcare Provider Details

I. General information

NPI: 1952471278
Provider Name (Legal Business Name): EARL DAVID SMITH D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 04/12/2023
Certification Date: 04/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 LEGION ST
RINGGOLD GA
30736-2369
US

IV. Provider business mailing address

PO BOX 1091
RINGGOLD GA
30736-1091
US

V. Phone/Fax

Practice location:
  • Phone: 706-965-5777
  • Fax: 706-965-5787
Mailing address:
  • Phone: 706-965-5777
  • Fax: 706-965-5787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NI0900X
TaxonomyInternist Chiropractor
License Number6245
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: