Healthcare Provider Details

I. General information

NPI: 1568480226
Provider Name (Legal Business Name): MARY F. DAILEY-SMITH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 02/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1008 N PIEDMONT AVE
ROCKMART GA
30153-2526
US

IV. Provider business mailing address

5610 WENDY BAGWELL PKWY SUITE 103
HIRAM GA
30141
US

V. Phone/Fax

Practice location:
  • Phone: 770-684-6100
  • Fax: 770-684-8294
Mailing address:
  • Phone: 770-943-7808
  • Fax: 770-943-7805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number050472
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: