Healthcare Provider Details

I. General information

NPI: 1104829837
Provider Name (Legal Business Name): GEORGE J SMITH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2005
Last Update Date: 03/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

428 CLAYMONT CT
MADISONVILLE LA
70447-3432
US

IV. Provider business mailing address

428 CLAYMONT CT
MADISONVILLE LA
70447-3432
US

V. Phone/Fax

Practice location:
  • Phone: 504-441-8732
  • Fax:
Mailing address:
  • Phone: 504-441-8732
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD018929
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD.201339
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: