Healthcare Provider Details

I. General information

NPI: 1548252448
Provider Name (Legal Business Name): SMITH OF GEORGIA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2005
Last Update Date: 04/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4280 N VALDOSTA RD
VALDOSTA GA
31602-6814
US

IV. Provider business mailing address

4280 N VALDOSTA RD PO BOX 10010
VALDOSTA GA
31602-6814
US

V. Phone/Fax

Practice location:
  • Phone: 229-671-2000
  • Fax: 229-671-2054
Mailing address:
  • Phone: 229-671-2000
  • Fax: 229-671-2054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number092602
License Number StateGA

VIII. Authorized Official

Name: MR. SHAMB PUROHIT
Title or Position: CFO
Credential:
Phone: 229-671-2000