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General NPI Number Information
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NPI Number | 1558583492
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Entity Type | Individual
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Provider Name | THEODORE WILLIAMS SMITH M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/02/2007
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 100 EDGEWOOD AVENUE N.E. SUITE 1228
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City | ATLANTA
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State | GA
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Zip | 30303-3068
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Country | US
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Telephone | 770-319-1595
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Fax | 770-234-3934
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Provider Business Mailing Address
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Address Line | 3013 HAMPTON CLUB WAY
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City | LITHONIA
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State | GA
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Zip | 30038-5102
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Country | US
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Telephone | 770-319-1595
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Fax | 770-234-3934
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 032303
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 2084P0802X
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Taxonomy Name | Addiction Psychiatry Physician
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License Number | 032303
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License Number State | GA
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