Healthcare Provider Details

I. General information

NPI: 1831156306
Provider Name (Legal Business Name): YVONNE L. SMITH MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2006
Last Update Date: 07/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4910 JONESBORO ROAD
UNION CITY GA
30291-2085
US

IV. Provider business mailing address

4910 JONESBORO ROAD
UNION CITY GA
30291-2085
US

V. Phone/Fax

Practice location:
  • Phone: 770-964-7736
  • Fax: 770-306-1726
Mailing address:
  • Phone: 770-964-7736
  • Fax: 770-306-1726

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number042443
License Number StateGA

VIII. Authorized Official

Name: DR. YVONNE LORRAINE SMITH
Title or Position: CEO
Credential: MD PC
Phone: 770-964-7736