Healthcare Provider Details

I. General information

NPI: 1245247543
Provider Name (Legal Business Name): JAMES DEREE SMITH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 03/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5354 REYNOLDS ST STE 422
SAVANNAH GA
31405-6011
US

IV. Provider business mailing address

602 E 72ND ST
SAVANNAH GA
31405-4913
US

V. Phone/Fax

Practice location:
  • Phone: 912-355-5593
  • Fax: 912-355-5404
Mailing address:
  • Phone: 912-819-7878
  • Fax: 912-819-7850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number16431
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: