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General NPI Number Information
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NPI Number | 1326340829
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Entity Type | Organization
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Legal Business Name | SMOKERISE FAMILY MEDICAL ASSOC
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Dates
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Enumeration Date | 12/03/2010
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Last Update Date | 12/03/2010
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Provider Practice Location Address
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Address Line | 1505 LILBURN STONE MOUNTAIN RD STE 100
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City | STONE MOUNTAIN
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State | GA
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Zip | 30087-1857
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Country | US
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Telephone | 770-469-1711
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Fax | 770-469-1837
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Provider Business Mailing Address
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Address Line | 1505 LILBURN STONE MOUNTAIN RD STE 100
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City | STONE MOUNTAIN
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State | GA
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Zip | 30087-1857
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Country | US
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Telephone | 770-469-1711
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Fax | 770-469-1837
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Authorized Official
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Title or Position | FAMILY PHYSICIAN/PRESIDENT
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Name | MR. MICHAEL LESLEY BARON
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Credential | D.O.
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Telephone | 770-469-1711
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 0033273
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License Number State | GA
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