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General NPI Number Information
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NPI Number | 1801167325
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Entity Type | Organization
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Legal Business Name | EDWARD J SMITH DC PC
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Dates
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Enumeration Date | 01/13/2012
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Last Update Date | 01/13/2012
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Provider Practice Location Address
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Address Line | 564 CHARLIE SMITH SR HWY
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City | SAINT MARYS
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State | GA
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Zip | 31558-3000
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Country | US
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Telephone | 912-882-7880
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Fax | 912-882-7311
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Provider Business Mailing Address
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Address Line | PO BOX 5035
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City | SAINT MARYS
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State | GA
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Zip | 31558-5035
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Country | US
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Telephone | 912-882-7880
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Fax | 912-882-7311
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. EDWARD J SMITH
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Credential | D.C.
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Telephone | 912-882-7880
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 2860
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License Number State | GA
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